DISCLOSURE STATEMENT
This Disclosure Statement provides important information to help you understand the terms of our agreement, make informed decisions, and ensure transparency. By working with me, you acknowledge and agree to the terms outlined here.
My hope for you is to unfold into your own healing and to clear and open the energetic obstacles so your life force (qì 氣) may shine through. I believe in a caring environment our self-healing capacity naturally emerges from within. I use various techniques to guide you into deeper parts of yourself, so that you may learn about and understand yourself on an experiential level. Techniques used include but are not limited to: awareness practices, sound healing, breathwork, consented touch, guided meditation, ritual, movement, art, writing, myth and story.
Limitations of this Work
There is no way to predict the results of this work. Some feel relaxation, well-being, and peace. Others experience moving energy, emotional release, release of memories from the past, or visions of images and colors. Some develop insight into an area of life. Others may feel nurtured or have what they describe as spiritual experiences. Some may experience very little. Sometimes difficult memories or feelings may surface during the course of this work. I encourage you to discuss your experiences with me, as they may be an important part of your healing. This work is not meant to treat any mental health or other medical condition.
Scope of Practice
It is important that you understand that this is not psychotherapy, counseling, or medical health care of any kind. This work is not being done under a license as a mental health practitioner, and as such, the same rights, privileges, and restrictions are not extended to this work. If you feel like psychotherapy or counseling would be helpful, I will be happy to give you an outside referral.
Confidentiality
Because it is not health care, this work does not fall under the scope of HIPAA. However, it is my intention and commitment to you to protect your personal information and confidentiality to the best of my ability, always. I will always act to maximize your privacy even when you waive your confidentiality. I will not disclose any of your information, or the fact that we are engaged in a professional relationship, to anyone under any circumstances, EXCEPT as follows:
You may request that I destroy the file I keep of your records at any time.
Consultation
I seek on-going consultation from other professionals as part of my desire to bring you the best possible care. Thus, at times, I may share pieces of your story with a consultation group or colleague. As much as possible, when sharing such information, I will protect your privacy and limit the information I share to the minimum necessary.
Professional Boundaries
It is my intention to maintain a relatively comfortable, safe, and professional environment where I consider your best interests my priority. Because I have the utmost respect for you and our relationship, professional boundaries are essential so that no harm or damage is done. I uphold the following practices regarding professional relationship boundaries:
Appointments
Fee Structure and Payment Methods as of January 2024 **
60 minutes - $225
90 minutes - $300
Day Long Intensives - $1600
Method for Determining Prorated Fees
Prorated fees accumulate at 10-minute intervals, based upon a $225/60-minute fee structure. $225 divided by 60 = 3.75, which is multiplied by the # of minutes rounded up to 10. This works out to $37 for up to 1-10 minutes, $75 for 11-20 minutes and so on.
Reduced Session Fees
Communication
I prefer to keep all communication within our scheduled sessions. If any phone or email conversation exceeds 10 minutes, it will be billed at my hourly rate and automatically charged to your credit card. I also request that email or text messages be used only for logistical purposes, as I prefer not to discuss the content of our work through these channels. I strongly recommend using encrypted communication services like Signal.
CLIENT ACKNOWLEDGEMENT, AGREEMENT, AND CONSENT
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Limitations of this Work
There is no way to predict the results of this work. Some feel relaxation, well-being, and peace. Others experience moving energy, emotional release, release of memories from the past, or visions of images and colors. Some develop insight into an area of life. Others may feel nurtured or have what they describe as spiritual experiences. Some may experience very little. Sometimes difficult memories or feelings may surface during the course of this work. I encourage you to discuss your experiences with me, as they may be an important part of your healing. This work is not meant to treat any mental health or other medical condition.
Scope of Practice
It is important that you understand that this is not psychotherapy, counseling, or medical health care of any kind. This work is not being done under a license as a mental health practitioner, and as such, the same rights, privileges, and restrictions are not extended to this work. If you feel like psychotherapy or counseling would be helpful, I will be happy to give you an outside referral.
Confidentiality
Because it is not health care, this work does not fall under the scope of HIPAA. However, it is my intention and commitment to you to protect your personal information and confidentiality to the best of my ability, always. I will always act to maximize your privacy even when you waive your confidentiality. I will not disclose any of your information, or the fact that we are engaged in a professional relationship, to anyone under any circumstances, EXCEPT as follows:
- If I believe that you are likely to do harm to yourself or to another person, I will take steps to protect you and/or the other person.
- If I believe that either a minor child or a vulnerable adult has been abused or neglected, I will report this to either Child Protective Services, Adult Protective Services, or a law enforcement agency. I will, in most cases, discuss my concerns with you first.
- If information is subpoenaed by a court. Again, I will do my best to protect you in these cases, but may be forced to share your personal information.
- If you commit or threaten a crime against me or within my office premises, your information may be disclosed. This includes damage to property.
- I sometimes share information with other practitioners, often for the purposes of consultation, but also to maintain safety for all of us. In general, we all strive to maintain confidentiality and not reveal any identifying information. However, in a situation where we learn something about a client which indicates that this work may be unsafe for us or them, we may share the minimal amount of information to help us assess safety, including your identity.
You may request that I destroy the file I keep of your records at any time.
Consultation
I seek on-going consultation from other professionals as part of my desire to bring you the best possible care. Thus, at times, I may share pieces of your story with a consultation group or colleague. As much as possible, when sharing such information, I will protect your privacy and limit the information I share to the minimum necessary.
Professional Boundaries
It is my intention to maintain a relatively comfortable, safe, and professional environment where I consider your best interests my priority. Because I have the utmost respect for you and our relationship, professional boundaries are essential so that no harm or damage is done. I uphold the following practices regarding professional relationship boundaries:
- I will not, at any time, have a social relationship with you outside of my office, even after we have ended our professional relationship. This is a professional boundary, not one of not caring. In this same vein, I will not accept social network “friend” requests.
- Before you share reviews or commentary about me in a public or semi-public forum, I request that you communicate your intent to do so prior to actually doing it. This is to keep communication flowing between us. In other words, if you have feedback for me (positive, negative, or ambivalent) it is best for us to discuss this in person as it is likely very important for your work. I always appreciate word of mouth referrals of your friends and associates.
- I will not, at any time, have sexual contact with you. I will ask for your consent on a case-by-case basis if non-sexual physical contact is indicated, and you may rescind your consent at any time.
- I will not, at any time, accept any gifts from you.
- If I were to see you in public at any time, I will not initiate any contact with you, out of respect for your confidentiality. If you initiate, I will respond in kind, but no further than you offer.
- I will not, at any time, have a relationship with you beyond the range our work, unless it is clearly negotiated (for example, if you become a student of mine).
Appointments
- You agree to give a minimum of 48 hours advance notice if you need to change or cancel your appointment.
- You will be responsible for the full fee when cancellations are received less than 48 hours in advance.
- You wil be responsible for the full fee when you are more than 10 minutes late to your appointment.
- It is important that we honor our time agreement and start and end on time. If you are late, we will end on time and not run over into the next person’s session.
- Missed and canceled sessions pose some issues for both of us. First, the healing work is sometimes challenging and when we hit a difficult place together, it can feel easier to want to avoid coming in. Please opt to discuss this intentionally rather than canceling sessions.
- Please anticipate this policy being discussed in a consistent and straightforward manner when an appointment is missed without notice.
Fee Structure and Payment Methods as of January 2024 **
60 minutes - $225
90 minutes - $300
Day Long Intensives - $1600
- I require a credit card on file and the fee will be automatically billed at the time of your session.
- You agree to give a minimum of 48 hours advance notice if you need to change or cancel your appointment.
- You will be responsible for the full fee when cancellations are received less than 48 hours in advance.
- You will be responsible for the full fee when you are more than 10 minutes late to your appointment.
- All fees are subject to change, and you will be notified 90 days in advance.
- Because this is not health care, insurance will not be accepted or charged for this work.
- I do not permit clients to carry a balance. Please let me know if any problem arises during the course of our work together.
- **At times, a session runs over, due to healing necessity and/or opportunity, however please know I try my utmost to end on time. In such a case, it is presumed that the additional time will be prorated and and ideally, we will pause briefly and check in about going over, and contract to do so.
Method for Determining Prorated Fees
Prorated fees accumulate at 10-minute intervals, based upon a $225/60-minute fee structure. $225 divided by 60 = 3.75, which is multiplied by the # of minutes rounded up to 10. This works out to $37 for up to 1-10 minutes, $75 for 11-20 minutes and so on.
Reduced Session Fees
- I maintain space for clients whose motivation and need are higher than their ability to pay the standard session rate.
- Please request this consideration only if all of the following conditions apply: 1) you have completed the intake session, and we are in agreement that we are a good match as client and guide; and 2) paying the standard fee would be an obstacle to the payor’s ability to afford food, housing, childcare, and/or transportation.
- Reduced session fees also apply to the formula used to calculate prorated services such as extended sessions, missed appointment fees, or Special Fees (see below). This means prorated fees will also be less expensive, which I deem to be consistent and fair.
Communication
I prefer to keep all communication within our scheduled sessions. If any phone or email conversation exceeds 10 minutes, it will be billed at my hourly rate and automatically charged to your credit card. I also request that email or text messages be used only for logistical purposes, as I prefer not to discuss the content of our work through these channels. I strongly recommend using encrypted communication services like Signal.
CLIENT ACKNOWLEDGEMENT, AGREEMENT, AND CONSENT
- I understand that if I have any questions or would like additional information, I am free to ask during the initial session and any time during our work together
- I agree to take full responsibility for my emotional, physical, spiritual, and mental well-being.
- I understand that confidentiality cannot be assured for electronic communication like cell phone and e-mails. I do not hold Nalu Center, LLC or Jendi Watson responsible or liable for breach of confidentiality if I choose to communicate with them by these electronic means.
- I agree my participation is fully at my own will. I agree to communicate clearly and directly and will ask for and/or negotiate for what I want.
- I understand that sometimes in doing this work things get worse (because of repressed issues and systematic dynamics) before things get better. I understand this may be a natural part of the process. I understand that Nalu Center, LLC or Jendi Watson encourages their clients to discuss these issues with them. Jendi has informed me and I understand that no guarantee or promises of cures have or will be made to me and that any benefits which I experience come from within my own awareness and self-knowledge.
- I have received and reviewed this Disclosure Statement. I have had the opportunity to ask any questions regarding this material and understand the information provided. I am of sound mind and body, participate voluntarily, and understand that I am personally responsible for my experience.
- I agree to all the above and agree to hold harmless Jendi Watson and Nalu Center for Healing LLC from any and all claims, lawsuits, costs, expenses, or liability of any kind for injury or damage resulting from negligence or other acts, arising from or relating to my education or participation in consultation with Jendi Watson.
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