Practice: Energy 2 Energy, LLC. Practitioner: Marni Washington. Please read the full form below, then check the box to confirm you agree.
1. Description of services
Energy medicine services are holistic, non-invasive approaches intended to support overall well-being by addressing energetic, emotional, and stress-related imbalances within the body. Techniques may include, but are not limited to, methods such as the Body Code, Emotion Code, Belief Code, and other integrative, mind-body practices.
These services are designed to support the body's natural ability to restore balance and are not a substitute for medical or mental health treatment.
2. Scope of practice
- I understand that energy medicine is considered a complementary and alternative approach.
- I understand that the practitioner does not diagnose medical or psychiatric conditions, prescribe medications, or provide licensed medical or psychotherapy services (unless otherwise disclosed).
- I understand that results may vary and no specific outcomes are guaranteed.
3. Not a substitute for medical or mental health care
- I understand that these services are not a replacement for care from a licensed physician, psychiatrist, psychologist, or other healthcare provider.
- I agree to continue any prescribed medical or mental health treatment and to consult my provider regarding any concerns.
4. Potential benefits and risks
Potential benefits may include:
- Increased sense of emotional relief or clarity
- Reduction in stress or energetic discomfort
- Enhanced overall well-being
Possible risks may include:
- Temporary emotional discomfort or release
- Fatigue or shifts in mood
- Unanticipated emotional or physical responses
I understand that these responses are generally temporary.
5. Client responsibility
- I acknowledge that I am an active participant in my healing process.
- I understand that I am responsible for my own physical, mental, and emotional well-being.
- I agree to communicate openly about my experiences during sessions.
6. Confidentiality
All information shared will be kept confidential in accordance with applicable laws and ethical standards, with the following exceptions:
- Risk of harm to self or others
- Suspected abuse or neglect (as required by law)
- Court order or legal requirement
7. Remote / energetic work (if applicable)
I understand that sessions may be conducted in person or remotely. I consent to receive energy work at a distance and understand that the practitioner may use intention-based methods that do not require physical touch.
8. Touch (if applicable)
I understand that some techniques may involve light, non-invasive touch. I may decline or withdraw consent for touch at any time.
9. Payment and cancellation policy
Fees for services are due upon booking. Cancellations require 24-hour notice; a late cancellation is subject to a $30 fee, and a missed appointment without notice is charged the full session amount. I understand that I am responsible for payment of services as agreed.
10. Voluntary consent
I have read and understand this consent form. I have had the opportunity to ask questions, and all questions will be answered to my satisfaction before my session. I voluntarily consent to receive energy medicine services.
