Informed consent is a process of communication between us regarding permission for services. Every client has the right to information and to ask questions.
I provide a paper copy of my informed consent form at your session appointment. The content of the paper copy of my form is provided below so that you can review in advance of your session, if you desire.
I understand that Patricia Iannone is a Licensed Spiritual Healer (LSH) qualified, within her scope of practice, to help me accept Divine healing on every level of my being according to my faith and beliefs and authorized to perform Spiritual Health & Wellness Coaching.
I also understand that the State of Illinois issues licenses to health and wellness professionals authorizing them to analyze, assess, diagnose, evaluate, examine, and investigate their patients to determine what is 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 is wrong with them.
I understand that Pat will refer me to a properly licensed professional if I need -- or if I feel that I need -- a specialist to diagnose, treat, counsel, or cure me of anything.
I further understand that Pat will coach, demonstrate, explain, instruct, empower, facilitate, mentor, teach, or tutor me to help me make my own decisions concerning my health and wellness.
I understand that Patricia Iannone is a Certified Emotion Code Practitioner (CECP), Certified Body Code Practitioner (BCP2), and Certified Belief Code Practitioner (BCP3) and that these methods seek to identify and eliminate underlying imbalances by releasing energetic imbalances in the areas of belief systems, energy, circuitry, pathogens, structure, toxicity, and nutrition. These methods of energy healing promote harmony and balance within, relieving stress and supporting the bodyʼs natural ability to heal.
I understand that energy healing such as these methods is widely recognized as a valuable and effective complement to conventional medical care.
I understand that I am advised to be self-informed about this work by visiting Dr. Bradley Nelson's website: www.healerslibrary.com and/or by reading his books on these techniques.
I understand that Patricia Iannone is a Certified Emotion Code Practitioner (CECP), Certified Body Code Practitioner (BCP2), and Certified Belief Code Practitioner (BCP3). These methods seek to identify and eliminate underlying imbalances by releasing energetic imbalances in the areas of belief systems, energy, circuitry, pathogens, structure, toxicity, and nutrition. These methods of energy healing promote harmony and balance within, relieving stress and supporting the bodyʼs natural ability to heal.
I understand that energy healing such as these methods is widely recognized as a valuable and effective complement to conventional medical care.
I understand that I am advised to be self-informed about this work by visiting Dr. Bradley Nelson's website: www.healerslibrary.com and/or by reading his books on these techniques.
I understand that Patricia Iannone is a Board Certified Raindrop Specialist (BCRS) and a Completely Certified CARE Instructor (CCCI), who is qualified to help me make more informed decisions about my own health and wellness and to trust my own intuitive insights.
I understand that the Raindrop Technique is an application of essential oils and a non-secular art and science.
I also understand that aromatherapy and the use of essential oils may help me reduce my stress, manage my pain, detoxify my body, improve my mental abilities, or improve my quality of life.
I further understand that human responses to essential oils may vary considerably and are not predictable because of each person's unique chemistry, makeup, and intent. I have read and understand the Eleven Points to Mention as a Prelude to Raindrop and/or the Statistical Validation of Raindrop Technique.
I understand that Patricia Iannone is a Certified Aromatherapy Coach (CAC) and is trained to coach, demonstrate, educate, empower, explain, facilitate, instruct, mentor, quiz for knowledge, supervise, teach, test for knowledge, train, or tutor clients on learning to take responsibility for their own health and wellness.
I understand that Pat uses aromatherapy in her services because it may help clients reduce their stress, manage their pain, enhance their peak performance, detoxify their body, mind, and spirit, or improve the quality of their lives.
I understand that Patricia Iannone is an Usui/Holy Fire III Reiki Ryoho Master Teacher practitioner and does not diagnose conditions, prescribe or perform medical treatment, prescribe substances, or interfere with the treatment of a licensed medical professional.
I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I also understand that the body can heal itself and to do so, complete relaxation is often beneficial.
I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed healthcare professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving.
I acknowledge that long-term imbalances in the body sometimes require multiple sessions to facilitate the level of relaxation needed by the body to heal itself.
I understand that my health, healing, and well-being are my responsibility.
I understand it is my responsibility to advise Pat of anything that might help us work together better to achieve the healing I seek.
I also understand that the natural techniques offered by Pat are not a substitute for adequate medical care. I intend to remain under the care of my primary healthcare provider.
I further understand that I might experience some discomfort as emotional issues arise while I am healing myself. I also understand all healing may cause some minor discomfort, and some adverse side effects may occur through no fault of my own or Pat.
I understand that Pat is merely a facilitator of the energies and guides them through spiritual techniques or quantum healing tools.
I understand that my identity and any information about me, whether I share it with Pat, or she discovers it on her own, will be held in the strictest confidence, except when released by me or specifically required by law. I have the right to waive this confidentiality agreement in whole or part at any time.
I understand that Pat must report illegal activities, felonies, abuse, and threats of suicide, or respond to subpoenas according to Federal, State, and local laws. She will also report abuse and neglect of animals to the proper authorities.
I have read, understand, and agree to abide by the Policies and Procedures published by Patricia Iannone and fully explained to me.
I acknowledge that I have read and understand this form.
Pat has answered all my questions to my satisfaction.
I agree to allow Pat to help me learn to heal myself using the natural healing techniques and modalities, but not limited to those listed in this document.
I hereby request and consent to the techniques of energy, spiritual, or distance healing modalities within the scope of Patricia Iannone’s healing techniques.
Revised 12/30/2024
I consent to receiving emails from Patricia Iannone and GinkgoTreeHealing.com.
Email address:___________________________________________________
Client Printed Name:___________________________________________
Full Address: ____________________________________________________
Client or Guardian Signature:__________________________________
Date:____________________________________________________________
Usui/Holy Fire® is the registered service mark of William Lee Rand.