Intake and Consent 

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CLIENT CONSENT FOR ENERGY WORK SESSIONS

Michael Rackov, Energetic Intentions owner and operator, is not a doctor or therapist. 

I understand that energy healing is a simple, gentle, hand-on energy technique that is used for stress reduction and relaxation.  I understand that energy practitioners do not diagnose conditions, nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional.  I understand that energy healing does not take the place of medical care.  It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have.  I understand that energy healing can complement any medical or psychological care I may be receiving.  I also understand that the body has the ability to heal itself and to do so, complete relaxation is beneficial.  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. 

No information about the client will be discussed or shared with any third party without written consent of the client or parent / guardian if the client is under 18. 

I understand that Energetic Intentions’ energy sessions are a gentle, complementary energy-based approach to health and healing that can assist my body in its natural ability to heal. I fully acknowledge and understand that this is accomplished using contact and/or non-contact touch. I was informed these sessions are a treatment to facilitate harmony and balance in the energy system creating an optimal environment for the body’s innate tendency for healing to occur.

Energetic Intentions’ energy sessions complement and support other traditional, medical, and health treatments. I understand that these sessions are not diagnostic, nor do they guarantee any cures, and I understand a practitioner does not interfere with any directions from a qualified healthcare provider. I understand that these sessions are confidential.  Except in the case of gross negligence or malpractice, I or my representative(s) agree to full release and hold harmless Michael Rackov from and against all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

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