COMPLEMENTARY & ALTERNATIVE HEALTH CARE CLIENT BILL OF RIGHTS & LIABILITY RELEASE

Please read and sign this complementary and alternative health care client bill of rights. I, Anna Meyer, Founder and Owner of Formation Healing Arts LLC, am providing you with this client bill of rights in accordance with Minnesota Statue Sec. 146A.11 governing unlicensed complementary and alternative health care practitioners.


Practitioner Name: Anna Meyer, Founder and Owner, Formation Healing Arts LLC

Complementary and Alternative Health Care Titles: Holistic Health Practitioner

Certified Usui Holy Fire Reiki Practitioner Degrees 1 & II

Certified Trauma-Sensitive HeartMath Practitioner

Biodynamic Craniosacral Therapy Practitioner

Business Mailing Address:   Anna Meyer, Formation Healing Arts LLC

3819 5th Ave S, Mpls, MN 55409 Telephone Number: 612-787-2683


Degrees, training, experience, or other qualifications regarding the complementary and alternative health care being provided and the statutory important disclosure statement in bold print below: Anna Meyer graduated cum laude with a Bachelor of Arts degree from the University of Minnesota in Women’s Studies with an emphasis on Queer and Gender Studies, Studio Arts and American Indian Studies in 1999. Anna trained for Biodynamic Craniosacral Therapy with a cohort of healing justice centered practitioners organized and supported through the People’s Movement Center in Minneapolis through Body Intelligence with teachers Nancy Seigel, Lauren Miller, Nancy Schrauth and Guy Odishaw from 2018-2020. Anna trained for Holy Fire Usui Reiki Degrees I & II through the MN Reiki Center for Training & Healing with Holy Fire Usui Master Reiki Teacher Jill Theil in 2020. Anna trained for The Resilient Heart: Trauma-Sensitive HeartMath Practitioner techniques with the HeartMath Institute in 2021. Anna is currently enrolled in Alchemical Alignment: Bodywork for Trauma Resolution and Embodiment of Spirit Training Program with Teacher Brigit Viksnins to be completed in fall 2021.


"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 INFORMATION 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, osteopathic physician, 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."


Client Rights:

You have the right to be treated with courtesy and respect, free from verbal, physical or sexual abuse by any practitioner or staff member.

You have the right to complete and current information regarding assessment and recommendations for treatment.

You may have access to your records. Your records are confidential unless you have authorized in writing a release of your records.

Other services are available in the Twin Cities and surrounding area to which I may refer my clients. You have the right to choose freely among the available practitioners and to change practitioners or discontinue treatment after services have begun.

You have the right to coordinated transfer when there will be a change in the provider of services.


Filing a Complaint: If there is ever anything you are uncomfortable with during our working together, please bring this up to me. It can be challenging to do so, and it holds the opportunity for greater healing for both of us. I will do my best to remedy the situation if I am at all able. If you remain dissatisfied or wish to contact an outside agency about your concerns you may call or write without fear of retaliation:

Minnesota Department of Health Health Occupations Program Office of Alternative and Complementary Health Care Practice P.O. Box 64882 St. Paul, Minnesota 55164-0882 Phone: (651) 201-3729 Fax: (651) 201-3839


Description of Therapy: Biodynamic Craniosacral Therapy (BCST) is a gentle, light touch therapy, BCST releases tensions held deep in the body and central nervous system. This release allows for the possibility of self-alignment and balance in all systems of the body. BCST is performed with the client fully clothed, on a comfortable massage table, in a quiet and nurturing environment. Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered from a distance, by light touch or hands close to the body, and is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive. If one's "life force energy" is low, then we are more likely to get sick or feel stress, and if it is high, we are more capable of being happy and healthy, HeartMath techniques are simple tools that focus on teaching us how to listen to, and follow, the intuitive information of the heart. We can learn how to better make decisions, and to use the power of the heart to manage the mind and emotions. The heart sends neurological information to the brain and the rest of the body. The core of the HeartMath philosophy is that the heart, physically and metaphorically, is the key to tapping into an intelligence that can provide us with fulfillment.


Insurance: At this time, Biodynamic Craniosacral Therapy, Reiki and HeartMath techniques are not covered by Medicare, Medical Assistance, or most insurances companies and HMO’s. However, Reiki and Craniosacral Therapy are sometimes eligible expenses for Health Savings Accounts/Flexible Spending Accounts; this sometimes requires a referral from a physician or chiropractor and sometimes does not require a referral. Reiki and Craniosacral Therapy are also sometimes covered in the case of an auto accident and workers compensation with a diagnosis and referral from a physician or chiropractor. Check with your insurance for details.


Fees & Payment Policies:

Full session $90.00 (usually 1 hour total). I also have an income based sliding scale fee available to folks with limited incomes upon arrangement prior to the session(s). The income based sliding scale fee scale range that is possible is $25-$89 per session. Auto Insurance and Workers Compensation related sessions are $130.00 per full session.

Sessions and packages are transferable and non-refundable. Payments are due at the time of treatment unless other arrangements are made prior to treatment. A missed appointment or a cancellation with less than 24-hour notice will be charged the full rate of the scheduled appointment. If I ever need to cancel a session, we have scheduled that you have already paid for, you have a choice to either have the session charge refunded at the same amount you paid or rescheduled for a future time.


Release of Liability: Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Anna Meyer, Formation Healing Arts LLC, and any location/organization/event/virtual platform where I receive sessions, from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).”


I hereby acknowledge receipt of the Client Bill of Rights 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.