Life Balance Cooperative Clinic New Client Terms & Agreement
I understand that the treatment plan that I co-create with Michelle Terrell or any practitioner affiliated with Life Balance Wellness Clinic, may include a combination of modalities. Including over-clothing body rocking, therapeutic placement of warm and cold stones, application of warm herb-infused compresses and general activating of the body via facilitated stretching and breathwork. Also, gentle pressure point application and static holds, known as Cranial Still Point Therapy, applied to the face, neck, and head, during facilitated breathwork and guided mediation. Therapist lead relaxation lessons can be done while laying on a therapy table, yoga mat or sitting in a chair based on the client’s comfort level.
I understand that the City of Mesa and the State of Arizona, do not offer, nor require, any licensing in order to provide these non-invasive relaxation therapeutics alongside coaching services. By signing this document today, I accept the care plan offered and agree to offer feedback and suggestions for improvement of care as session work proceeds. I further agree, that after researching and assessing Michelle Terrell’s training, academic achievements, and other related credentials, I have deemed her competent and properly trained to perform the therapeutic care outlined in my wellness plan.
It has been explained to me that massage therapy, legal counsel and other related services beyond the scope of those described in this agreement and wellness plan, will be referred out to another wellness-cooperative practice colleague, or to an outside office provider. I believe myself to be in good physical health and stable in my mental well-being to the extent required to participate in private session mind/body stress relief work designed to enhance emotional processing and relax the nervous system. If I am under a doctor’s care, I will share the details of that with Michelle Terrell as it may pertain to receiving optimum care or possible contraindications interfering with services offered by Life Balance Wellness Clinic.
The client shall remain full clothed during sessions, so soft comfortable clothing is suggested or drawstring linen pants and tunic will be provided. Sessions are arranged in advance by appointment.Payment will be handled at the point of care unless otherwise agreed. I understand that if less than 24 hrs notice is given for a session cancelation, the practitioner reserves the right to charge a $30 rebooking fee.
Printed Name _________________________________________________Email used to enroll online _________________________________________Phone number _____________________________
Signature ______________________________________________ Todays Date ____________________