Client Consent & Acknowledgment Form

1. Purpose and Scope of Services

I understand that the services offered by Erika Marie Ortiz with Easential Healing may include Reiki energy healing, somatic awareness and emotional processing, and Access Bars sessions.

These approaches are designed to support relaxation, release energetic and emotional blockages, encourage greater self-awareness, and help restore balance in the mind and body.

I acknowledge that these services are complementary and holistic in nature, and are not a substitute for licensed medical, psychological, or psychiatric diagnosis or treatment.

I understand that:

  • Reiki, Access Bars, and somatic awareness work are not licensed healing arts modalities under California law (Business and Professions Code § 2053.5 and § 2053.6).

  • The practitioner does not diagnose, treat, or prescribe for any physical or mental health condition.

  • I should continue to consult with my licensed healthcare providers for any medical or psychological concerns.

2. Client Responsibility

I acknowledge that my healing and growth process is my own. I agree to:

  • Communicate honestly about my physical, emotional, and mental well-being.

  • Inform the practitioner of any health conditions, medications, or treatments that may be relevant.

  • Take personal responsibility for my well-being during and after sessions.

I understand that results vary for each individual and that no outcomes are guaranteed.

3. Consent to Touch

I understand that Reiki, Access Bars, and somatic work may include light, non-invasive touch, or energy work performed just above the body.

The practitioner prioritizes your wellbeing and will always seek verbal consent before any physical contact.

I have the right to:

  • Decline or withdraw consent to touch at any time.

  • Request a completely hands-off session.

My comfort, safety, and boundaries will always be honored.

4. Emotional and Energetic Process

I understand that somatic and energy-based practices can bring awareness to physical sensations, emotions, and memories stored in the body. I acknowledge that:

  • This is a natural aspect of the body’s self-regulation and release process.

  • I may pause or end the session at any time.

  • The practitioner provides a supportive and grounded space, but does not offer psychotherapy or crisis intervention.

If I experience significant emotional distress, I agree to seek support from a qualified mental health professional or crisis resource.

5. Confidentiality

All information shared during sessions will remain confidential and will not be disclosed without my written consent, except where disclosure is required by law (e.g., risk of harm to self or others, abuse, or court order).

6. Scheduling, Payment, and Cancellation Policy

Sessions are by appointment only.

Cancellation Policy:
If you need to reschedule or make changes to your appointment, please reach out at least 24 hours before your appointment time. I’ll be happy to arrange a better day and time for your appointment.
Late cancellations and no-shows result in a 50% service charge of the original discounted treatment price. This ensures these times are available for someone who may need them. Your support is appreciated as I commit to providing the best experience for all patients. Thank you for your understanding and cooperation.

Payment is due at the time of service unless working with a prepaid treatment plan or an otherwise arranged payment plan. Late arrivals may shorten session time without a fee adjustment.

7. Practitioner’s Right to Discontinue Sessions

I understand that the practitioner reserves the right to decline or discontinue sessions at any time if it becomes clear that:

  • The work is outside the practitioner’s scope of practice,

  • The client’s needs would be better supported by another professional, or

  • The practitioner feels the session dynamic is no longer safe, ethical, or appropriate.

If this occurs, the practitioner will make every effort to communicate respectfully and may offer referrals or resources when appropriate.

8. Liability and Release

I acknowledge that I am voluntarily participating in Reiki, Access Bars, and/or somatic emotional processing sessions with [Practitioner’s Name].
I understand the nature and limits of these services and hereby release, indemnify, and hold harmless the practitioner and the practice from any and all liability, claims, or damages arising from my participation.

I understand that:

  • No guarantees or promises of specific results are made.

  • I am free to discontinue sessions at any time.

  • The practitioner may also discontinue sessions at their discretion, as outlined above.

  • My physical, emotional, and energetic well-being remain my own responsibility.

9. Acknowledgment and Consent

By starting treatments, I confirm that I:

  • Have read and fully understand this Consent & Acknowledgment Form.

  • Have had the opportunity to ask questions and have received satisfactory answers.

  • Voluntarily consent to receive Reiki, Access Bars, and/or somatic emotional processing services from [Practitioner’s Name] under the terms described above.