All clients are asked to sign the following form before their first session:
Consent for Treatment and Acknowledgement of Terms and Conditions
Shamanic Healing and Counseling
Shamanic Healing and Shamanic Counseling are spiritual methods that follow ancient principles of shamanic practice, not of psychology or Western medicine. Shamanic Healing and Shamanic Counseling are not derived from one specific culture or ethnic tradition, but are based on core principles that have been adapted for use in contemporary life and society. These methods of spiritual counseling are aimed at life enlightenment, not the treatment of psychopathology or physical conditions. Shamanic Healing is a form of spiritual healing and is neither a form of psychotherapy nor a substitute for medical examination, diagnosis, or treatment. Shamanic Counseling is a problem solving system for discovering one’s own spiritual power and the wisdom to deal successfully with daily life. There are no guarantees as to the results of either of these methods.
___ By initialing here, I indicate the following:
- I understand the above explanation of the parameters of Shamanic Healing and Shamanic Counseling;
- I understand that during a Shamanic Healing session, the practitioner may lightly place their hands or shamanic tools (ie a rattle or feather) on or just my body;
- I have been informed about what to expect during a Shamanic Healing session or a Shamanic Counseling program;
- I fully consent to such treatment by Carolyn Herbst Lewis;
- and I hereby release Carolyn Herbst Lewis and Mamies Way Herbs, LLC from all claims, damages or suits which may arise during or developing in the future as a result of Shamanic Healing or Shamanic Counseling procedures.
Reiki
Reiki is a form of energy healing in which practitioners place their hands lightly on or just above a person, with the goal of directing energy to help facilitate the person’s own healing response. Reiki is based on an Eastern belief in an energy that supports the body’s innate or natural healing abilities. Reiki practitioners do not diagnose conditions, prescribe medicines, or interfere with the treatment of a licensed medical professional. Reiki is neither a form of psychotherapy nor a substitute for medical examination, diagnosis, or treatment, and these treatments are not intended as a substitute for medical or psychological care.
___ By initialing here, I indicate the following:
- I understand the above explanation of the parameters of Reiki;
- I have been informed about what to expect during a Reiki session, including that the practitioner will be placing their hands on my body during the session;
- I fully consent to such treatment by Carolyn Herbst Lewis;
- and I hereby release Carolyn Herbst Lewis and Mamies Way Herbs, LLC from all claims, damages or suits which may arise during or developing in the future as a result of Reiki Healing.
Terms and Conditions
Privacy and Confidentiality
Your privacy is extremely important to me. I do not collect any personal information about you unless you choose to provide that information by emailing, calling, or texting me, or by completing an online form. I do not share, sell, lend or lease any of the information that uniquely identifies a visitor (such as email addresses or personal details) with anyone except to the extent it is necessary to provide services that you have requested. Your sessions with me are completely private and confidential. I will not tell anyone else what you have told me without your prior permission, unless I am legally obligated to do so in order to report risks to yourself or others.
24-Hour Cancellation/No-Show Policy
Your session is very important to me, and it is reserved especially for you. I understand that emergencies and other scheduling conflicts arise and are sometimes unavoidable. I respectfully request at least 24 hours notice if you must change, cancel, or reschedule your appointment.
If I am not notified ahead of time and you miss your session, you will be coded as a no-show.
1st No-Show: You may contact me directly to reschedule without penalty.
2nd No-Show: You will be required to pay for all future sessions at the time of booking,
and will not be permitted to reschedule any future missed sessions or receive a
refund.
Late Arrival Policy
I have allotted a set amount of time for your Shamanic Healing, Shamanic Counseling, or Reiki session, and your session will be adjusted to fit into this timeframe, even if you arrive late:
- At 15 minutes past your session time, I will call, text, or e-mail you
- At 30 minutes past your session time, your session will be canceled and you will be coded as a no-show. See no-show policy above.
Inclement Weather Policy
Inclement weather generally includes severe weather activity creating hazardous driving conditions or significantly impairing normal business operations or actions and personal activities (e.g. ice, blizzard, flooding, etc.). I recognize that individual circumstances may affect your ability to come to your session during inclement weather conditions. You are responsible for using your own judgment in assessing whether or not to come to your session. If you are not comfortable coming due to weather conditions, please contact me before your session start time in order to reschedule.
Payment
All payments are to be made prior to the start of the session. This can be done via Venmo, credit card, or cash. I do not accept checks. There are no refunds for services once rendered.
I have fully read, understand, and agree to the above Consents for Treatment and Terms and Conditions.
Signed _____________________________ Date __________________
Provider contact and payment information:
Carolyn Herbst Lewis
225-892-0367
Venmo: @MamiesWay
Mamie's Way 