NEW CLIENT INFORMED CONSENT
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INTEGRATIVE SERVICES
Sacred Bodywork Informed Consent
I understand Rev. Lee Yen Anderson is an ordained Minister and Licensed Spiritual Healer (LSH) qualified to help me accept Divine healing on every level of my being according to my faith and beliefs, coach me to allow the Divine to heal me and to teach me to trust my own intuitive insights.
I understand that LeeYen Anderson is a Certified Raindrop Technique Specialist (CRTS) as certified by the Natural Therapies Certification Board (NTCB) qualified to administer the Raindrop Technique with Young Living Essential Oils which may help boost my stamina and energy, help me relax, and promote my overall health, vitality, and longevity.
I understand my own health and wellness is my responsibility. I also understand I have the ability to heal myself. I understand it is my responsibility to advise Lee Yen Anderson of anything that might help us work together better to achieve the healing I seek. Therefore I agree to use the services of LeeYen Anderson to empower me to learn how to make decisions for my own health, nutrition and wellness. I further understand that LeeYen’s service is not a substitute for adequate medical care and I intend to remain under the care of my primary healthcare provider.
I hereby request and consent to the technique of energy, spiritual or distance healing modalities within the scope of LeeYen Anderson’s healing techniques.
I understand LeeYen Anderson will keep all information she learns about me completely confidential unless I release her in writing or as required by law. I further understand LeeYen Anderson will not acknowledge my presence or discuss anything with me publicly unless I initiate the conversation and the topics of discussion.
I understand that the state of Hawaii issues licenses to health and wellness professionals authorizing them to analyze, assess, diagnose, evaluate, examine and investigate their patients to determine what's wrong with them. This license also authorizes them to advise, caution, counsel, guide, prescribe, recommend and suggest cures, drugs, interventions, remedies and treatments to address what's wrong with them. I understand LeeYen Anderson will refer me to a properly licensed professional if I need -- or if I feel I need -- a specialist to diagnose, treat, counsel or cure me of anything.
I understand that if I have -- or if I think I have -- a medical concern, condition, disease, disorder, issue or symptoms, LeeYen Anderson will help me reduce any related stress and refer me to a licensed chiropractic, medical or osteopathic physician for further assistance.
I also understand if I have -- or if I think I have -- a psychological or emotional concern, condition, disease, disorder, issue or symptoms, LeeYen Anderson will help me reduce any related stress and refer me to a licensed counselor, psychologist or psychiatrist for further assistance.
I have read and understand this form. I agree to pay LeeYen Anderson for teaching me how to accept Divine healing using the spiritual and natural healing techniques and modalities listed in this form.
I additionally understand that the services provided by LeeYen Anderson may cause certain adverse side effects such as:
1) skin rash from the application of essential oils, especially if I have sensitive skin or if I am releasing toxins from my body too rapidly and/or
2) discomfort as emotional issues arise through no fault of myself or Lee Yen Anderson.
If I have any concerns about these things, I will keep LeeYen Anderson fully advised about my concerns so the intervention may be terminated if necessary or revised to minimize any harm to me.
Holistic Life Coaching Informed Consent
Soul Coherence Voyage
I understand Rev. LeeYen Anderson is an Ordained Minister and Licensed Spiritual Healer (LSH) who practices Depth Psychology and is qualified to help me accept Divine Healing on every level of my being according to my faith and beliefs, coach me to allow the Divine to heal me and to teach me to trust my own intuitive insights.
I understand that LeeYen Anderson is a Certified Wayfinder Life Coach, a program that has been designed to meet the International Coach Federation (ICF) accreditation standards. I also understand that LeeYen Anderson is qualified to coach me on how to access my inner compass, that is the deep inner knowing that guides me, in the midst of changes in my life and to reclaim my true nature.
I also understand that LeeYen Anderson is a Certified Nutritionist Consultant, trained to coach and empower me to make informed choices about different foods and supplements that can support my wellness. I understand that LeeYen Anderson is qualified to educate me on detoxification of my physical body for optimal health of my body systems.
I understand my own health and wellness is my responsibility. I also understand I have the ability to heal myself. I understand it is my responsibility to advise LeeYen Anderson of anything that might help us work together better to achieve the healing I seek. Therefore I agree to use the services of LeeYen Anderson to empower me to learn how to make decisions for my own health, nutrition and wellness. I further understand that LeeYen’s service is not a substitute for adequate medical care and I intend to remain under the care of my primary healthcare provider.
I hereby request and consent to the technique of energy, spiritual or distance healing modalities within the scope of LeeYen Anderson’s healing techniques.
I understand LeeYen Anderson will keep all information she learns about me completely confidential unless I release her in writing or as required by law. I further understand LeeYen Anderson will not acknowledge my presence or discuss anything with me publicly unless I initiate the conversation and the topics of discussion.
I understand that the state of Hawaii issues licenses to health and wellness professionals authorizing them to analyze, assess, diagnose, evaluate, examine and investigate their patients to determine what's wrong with them. This license also authorizes them to advise, caution, counsel, guide, prescribe, recommend and suggest cures, drugs, interventions, remedies and treatments to address what's wrong with them. I understand Lee Yen Anderson will refer me to a properly licensed professional if I need -- or if I feel I need -- a specialist to diagnose, treat, counsel or cure me of anything.
I understand that if I have -- or if I think I have -- a medical concern, condition, disease, disorder, issue or symptoms, LeeYen Anderson will help me reduce any related stress and refer me to a licensed chiropractic, medical or osteopathic physician for further assistance.
I also understand if I have -- or if I think I have -- a psychological or emotional concern, condition, disease, disorder, issue or symptoms, LeeYen Anderson will help me reduce any related stress and refer me to a licensed counselor, psychologist or psychiatrist for further assistance.
I have read and understand this form. I agree to pay LeeYen Anderson for teaching me how to accept Divine healing using the spiritual and natural healing techniques and modalities listed in this form.
Sacred Movement Informed Consent
I understand Rev. LeeYen Anderson is a Certified Master Teacher of BaGuaZhang Shen Gung Internal Martial Arts, a 200-hr Certified ISHTA Yoga Teacher and a Certified Aroma Yoga® Teacher.
I understand that the movement class I participate in is designed for stress reduction, relief of muscular tension, improvement of mobility and circulation and general relaxation. I understand that LeeYen Anderson does not diagnose or treat illness, disease or any other physical or mental disorder nor does he/she prescribe medications.
I take full responsibility for informing him/her about any health condition that may affect my participation in this class.
I understand this class is not a substitute for medical examination or diagnosis and that it is strongly recommended that I see a physician for any health ailment that I might have.
I understand that I am agreeing not to make further claims or demands on and further, not to sue or take legal action against LeeYen Anderson for strict liability, malpractice, breach of contract or any other cause of action which may arise from this service.
I understand my own health and wellness is my responsibility. I also understand I have the ability to heal myself. I understand it is my responsibility to advise LeeYen Anderson of anything that might help us work together better to achieve the healing I seek. Therefore I agree to use the services of LeeYen Anderson to empower me to learn how to make decisions for my own health, nutrition and wellness. I further understand that LeeYen’s service is not a substitute for adequate medical care and I intend to remain under the care of my primary healthcare provider.
I hereby request and consent to the technique of energy, spiritual or distance healing modalities within the scope of LeeYen Anderson’s healing techniques.
I understand LeeYen Anderson will keep all information she learns about me completely confidential unless I release her in writing or as required by law. I further understand LeeYen Anderson will not acknowledge my presence or discuss anything with me publicly unless I initiate the conversation and the topics of discussion.
I understand that the state of Hawaii issues licenses to health and wellness professionals authorizing them to analyze, assess, diagnose, evaluate, examine and investigate their patients to determine what's wrong with them. This license also authorizes them to advise, caution, counsel, guide, prescribe, recommend and suggest cures, drugs, interventions, remedies and treatments to address what's wrong with them. I understand LeeYen Anderson will refer me to a properly licensed professional if I need -- or if I feel I need -- a specialist to diagnose, treat, counsel or cure me of anything.
I understand that if I have -- or if I think I have -- a medical concern, condition, disease, disorder, issue or symptoms, LeeYen Anderson will help me reduce any related stress and refer me to a licensed chiropractic, medical or osteopathic physician for further assistance.
I also understand if I have -- or if I think I have -- a psychological or emotional concern, condition, disease, disorder, issue or symptoms, LeeYen Anderson will help me reduce any related stress and refer me to a licensed counselor, psychologist or psychiatrist for further assistance.
I have read and understand this form. I agree to pay LeeYen Anderson for teaching me how to accept Divine healing using the spiritual and natural healing techniques and modalities listed in this form.