Forms

WELLBEING: Holistic Counseling

CLIENT BILL OF RIGHTS

Tasha Burg, MA

Tashaleejo@gmail.com 612.839.7100

I am pleased to provide you with this Client Bill of Rights, in accordance with Minnesota laws governing complementary and alternative health care practices. MN Statute 146A

Degrees, training, and experience:

Master of Arts degree in Holistic Counseling from Salve Regina University in Newport, RI with coursework in Expressive Art Therapy. Bachelor of Arts in Liberal Studies with an emphasis in Psychology and Communication from College of St. Benedict & St. John's University in St. Joseph, MN. Reiki Practitioner (level III) with Beth Henning of the Tao Institute, St. Cloud, MN Rosen Method coursework from Rosen Center East, Connecticut and Southwest in Santa Fe, New Mexico. Heartwood Institute Anatomy/Physiology Intensive in Garberville, CA; Omega Institute coursework in The Art of Empowerment: A Professional Training in Facilitating Human Potential in Rhinebeck NY, Wellness Counselor at Hazelden Betty Ford Foundation in Center City, MN and Institute of Transpersonal Psychology studying coursework in Spiritual Development.

THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY.

Under Minnesota law, an unlicensed complementary and alternative health care practitioner may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or services from a physician, chiropractor, nurse, osteopath, physical therapist, dietitian, nutritionist, acupuncture practitioner, athletic trainer, or any other type of health care provider, the client may seek such services at any time.

Supervisor. Tasha Burg is your Case Supervisor. Her name and office address are listed above. You have the right to file a complaint with her by writing a letter with details of the nature of the complaint.

Right to file a complaint. If you have any concerns, you may file a complaint with the following offices.

· Office of Unlicensed Complementary and Alternative Health Care Practice

Health Occupations Program, Minnesota Department of Health

121 East Seventh Place, Suite 400, PO Box 64975, St. Paul, MN 55164-0975

651-282-6319, 1-800-657-3957, Fax 651-282-5628

· Associated Bodywork & Massage Professionals,

1271 Sugarbush Drive, Evergreen, CO 80439-9766 1-800-458-2267

Fees for unit of service. Fees are payable at the time of service, by cash, or check. $75 per hour. Each additional ½ hour is $20. We do not accept insurance Medicare, Medical Assistance, or General Assistance Medical Care. Change in services or charges. You have a right to reasonable notice of changes in services or charges, and we will provide prior notice of any changes.

Description of services. Wellness Counseling or guidance is based on a holistic model, which is founded in the connection of the whole person in body, mind and spirit. The Holistic model recognizes that the body is naturally self-healing. In addition, the body heals best under the condition of relaxation. The process includes becoming aware of our patterns of how we relate with our self and the environment physically, mentally, emotionally and spiritually. Thus, Wellness Counseling promotes authenticity of our deepest thoughts, emotions and hopes with our outward actions. The following techniques are used to facilitate this process when agreed upon by the client and practitioner: verbal processing or talking and listening, creative expressive art, integrative bodywork and/or energy work that may involve hands on the body. Clients remain fully clothed. Together, the client and practitioner explore the emotional patterns that often manifest physically and energetically often holding us back from living spiritually fulfilling lives. These methods are used to balance and integrate the whole person in body, mind and spirit to promote well-being, self-understanding, empowerment, clarity of life patterns and choices and release the root of the issues we face. Behavioral tools, such as deep breathing and biofeedback, may also be taught to manage symptoms of anxiety. Reiki, meaning universal life force energy, is the art of restoring balance physically, mentally, emotionally and spiritually. In Eastern philosophies, health is equivalent to the flow of energy through the body. However, when energy becomes blocked, pain, illness and disease may manifest. Reiki is often a “hands-on” technique, but may also be administered with the practitioner's hands not touching the client. Clients often experience a relaxing warmth, tingling, pulsing or “flow” through the body.

· You have a right to complete and current information concerning any assessment and recommended service, including the expected duration of the service to be provided. If you have any questions, please ask.

· You may expect courteous treatment and to be free from verbal, physical, or sexual abuse by the practitioner.

· Your records and other information about you are confidential. This information will not be released, unless you authorize release in writing, or unless release is required by law.

· You are allowed access to records and other written information, in accordance with Minnesota Statutes, section 144.335.

· You have the right to choose freely among available practitioners and to change practitioners after services have begun.

· If you change practitioners, you have the right to our assistance in coordinating this transfer to another practitioner.

· You have the right to refuse services or treatment, unless otherwise provided by law.

· No retaliation. You may assert your rights without retaliation.

I hereby acknowledge receipt of the Client Bill of Rights and the attached documents incorporated therein, and I have had a full opportunity to ask any questions I have about this document and my rights as a client. I understand my rights as a client.

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Client Signature Date Parent or Guardian Signature (if client is a minor)