Client Agreement for Service, Disclosures and Consent for Energy Work Sessions

Thank you in advance for taking the time to review the below, consider its contents and sign and submit once you feel ready to do so.  Should you have any questions that need to be addressed prior to completing, please feel free to notify me and we can address via email or discuss at the beginning of your Initial Session appointment.  

Energy work is a holistic well-being modality and constitutes a personal choice to pursue self-discovery, a path which only you can choose for yourself.   

– Meredith

Practitioner Name and Credentials

Meredith R. Woods
Energy Healing Practitioner certification, Energy Healing Institute (EHI)
Master of Acupuncture degree, New England School of Acupuncture (NESA)

The energy work services offered by Meredith are not licensed by the state of Oregon.

Practice Name and Location

Meredith Woods Energy Work
21 E 28th Ave, Suite 1, Eugene, OR 97405

Practice Scope

Energy Work
In-person and remote sessions

Practitioner Contact

Email: [email protected]
Phone: 541-321-0185

Definition of Energy Work

Energy Work is a holistic, integrated approach intended to clear, balance, support and evolve the human energy system to facilitate physical, emotional, mental and spiritual self-healing.  The trained practitioner uses clarity of intent and clean practice in applying  various energy modalities within a cohesive system (chakras and aura).

Energy work is not a form of bodywork or manual therapy, such as the work offered by a licensed massage therapist.

*Energy work is intended to complement and not replace any form of medical and/or psychotherapeutic care. Practitioners do not diagnose any conditions or prescribe any treatment.*

Session Information

Fees and Payment

75 minutes: $135.00
90 minutes: $155.00

Payment is accepted via credit card and is due at time of scheduling online. An automated receipt will be sent to you via email for your records.

Late Arrival and Appointment Cancellation Policy

I understand that arriving late for a session may result in a shortened appointment.

I agree to give 24-hour notice if it is necessary for me to cancel an appointment.  Meredith reserves the right to charge for the session if adequate notice is not given.

Confidentiality

All client records are kept in a secure location and treated in a confidential manner; no information will be released to anyone without my prior written consent, except in situations governed by law.

Disclosures

In-person energy work:

• Energy work involves the use of light touch on the body, and movement of hands in the space above and around the body, with the client always fully clothed and lying face up on the massage table.

Remote energy work:

• I understand that the same standard of care and same level of practitioner confidentiality applies to a remote session as to an in-person visit.
• I understand that I will not physically be in the same room as Meredith, and that our session will occur virtually using Zoom Workplace, either with or without video.
• I understand that sessions will not be recorded, by either Meredith or myself.
• Risks to confidentiality: I understand that certain aspects of privacy will be my responsibility including: ensuring that for the duration of the session I am in a private location where I will not be interrupted or overheard by others, and protection of the privacy of the session on the device that I choose to use.
• Issues with technology: I understand that there are risks to using technology including service interruptions, interception and technical difficulties. If it is determined that equipment, video conferencing or service connection is not adequate, I understand that either Meredith or I may discontinue the remote session and make arrangements to complete the session at another time.

General:

• How you feel during or after a session may vary. At times, you may feel an increased flow of energy throughout your body or personal space that generates a sense of well-being. The work can also bring about the release of emotions (i.e. grief, anger) or bring your attention to outdated patterns of behavior (i.e. relationships with family or co-workers). Clearing/shifting aspects in your energy system may be reflected in your overall awareness and in relationships with others.
• As part of a session, Meredith may offer/teach energy management skills for self-care. All tools offered for home use are completely optional.
• Goals for session work will be mutually identified during the intake and any further discussions; I have input in establishing goals for this work with Meredith.
• Meredith may periodically review my case with her supervisor, Jill Leigh, Energy Healing Institute, and a small group of peer colleagues to receive feedback and direction if needed. If my case is brought to supervision no personal identifiers will be used and confidentiality will be maintained.
• No specific claims are made by Meredith regarding the outcomes of energy work.

Hold Harmless Clause

Except in the case of gross negligence or malpractice, I or my representative(s) agree to hold harmless Meredith R. Woods and Meredith Woods Energy Work LLC from and against any and all claims or liability of whatsoever kind or nature, arising out of, or in connection with, my session(s).

[Document version 11.2024]