Disclaimer

Complementary & Alternative Health Care Client Bill of Rights AND Legal Waiver

I am providing you this Client Bill of Rights in accordance with Minnesota State Statue 146A governing licensed complementary and alternative healthcare practitioners. By reading this – you agree to all information provided.
Practitioner Name: Nicki Gordon
Telephone Number: 612-210-7617

Nicki Gordon, hereafter, “the practitioner” has received the following education, training & credentials:
Reiki Level I – MCTC – 2014
Reiki Level II – Reiki By Pink Lotus – 2014
Reiki Master – Rising Sun Reiki – 2017
Certificate of Energy Medicine – Normandale College – 2015

“THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IF FOR INFORMATIONAL PURPOSES ONLY. Under Minnesota law, an unlicensed complementary and alternative health care practitioner may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or services from a physician, chiropractor, nurse osteopath, physical therapist, dietician, nutritionist, acupuncture practitioner, athletic trainer, or any other type of health care provider, the client may seek such services at any time.”
Complaints: If the Client has a complaint or concern about he care or services they have received, the Client may also contact the Office Of Unlicensed Complementary and Alternative Health are Practice located in Minnesota Department of Health:
P.O. Box 64882, St. Paul, MN 55164
Phone: 651-201-3727 Fax: 651-201-3839 http://www.health.state.mn.us/divs/hpsc/hop/ocap/

Fees, Payment, Insurance: Payment is accepted by cash or check. This practitioner is not on contract with any HMO’s, PPO’s, or an other insurance company to provide discounted services. This practitioner does not accept Medicare, Medical Assistance, or general assistance medical care. Payment in full for services is expected at the time of service, unless otherwise arranged prior to the appointment. Nicki Gordon requires 24 hours notice for cancellations. Less than 24 hours notice or No Show will result in full session charge.
Change of Price: While changes in session fees can occur, reasonable notice of those changes will be provided or by the client asking when scheduling an appointment.
Theory of Treatment: The state requires a “Plain language” summary of the “theoretical approach used to provide service to clients.” Energy Healing accesses subtle, yet powerful, Universal Energy that utilizes deep relaxation to calm the mind and balance the body, promoting overall health and well-being. Right to Current Information: Clients have the right to complete and current information concerning the practitioner’s assessment and recommended service that is to be provided, including the expected duration of the service to be provided.
Right to Confidentiality: Client records are confidential and will not be released, unless authorized by the client in writing or otherwise provided for the law.
Right to Self Access: Clients have the right to access their own records maintained by the Practitioner’s office, in accordance with state statute sections 144.291 to 144.298
Personal Interaction: Clients have the right to expect courteous treatment, free from verbal, physical, or sexual abuse.
Other Treatment Available: Other Energy services are available to the Client in this same community. The can be located by asking the Practitioner or the provider who referred you to their practitioner, who will then provide to the best of their ability other Energy services in the community.
Right of Agency: The Client has the right to choose freely among available practitioners and to change practitioners after services have begun, within the limits of health insurance, medical assistance, or health programs.
Records Transfer: The Client has the right to coordinated transfer of your records when there will be a change in the provider of services.
Right of Refusal: The Client may reuse services or treatment, unless otherwise provided by the law. Right of Non-retribution: The Client has the right to assert any and all of the above-mentioned rights without retaliation from the Practitioner.

Waiver, Informed Consent, and Covenant Not to Sue
I hereby acknowledge I have volunteered to participate in a paid or unpaid session, class, workshop, service or program with Nicki Gordon Energy Healing, to include, but also may not be limited to, any and all services provided, such as energy healing, intuitive coaching, and guidance. I do here and forever release and discharge and hereby hold harmless Nicki Gordon and its respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in a session or purchase or any program WITHOUT LIMITATION, WHICH MAY OCCUR AS A RESULT OF following advice tendered and released or training rendered or use of facilities during a session or event.

I recognize that in no way does Nicki Gordon provide legal, medical, or therapeutic advice and it is my responsibility to secure such advisement. I acknowledge and agree that I assume the risks associated with any and all activities, offerings, products, services, classes and/or programs in which I participate or purchase.
I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from any insight, guidance, product or program. I understand that results are individual and may vary.

I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THE MN COMPLEMENTARY AND ALTERNATIVE HEALTH CARE BILL OF RIGHTS, AS WELL AS THE LEGAL WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST NICKI GORDON FOR NEGLIGENCE OR THAT OF ITS EMPLOYEES, AGENTS, OR CONTRACTORS.