(I) Overview and Contact Information

My name is Natalia Ronstadt Chang. My energetic healing sessions (Healing Touch, Reiki, Intuitive Healing, BioMat) and vibrational essence consultations take place in a private practice setting, community support events, and during classes I teach. Sessions, consultations and classes primarily take place by appointment only at 1545 McKendrie Street, San Jose, CA, 95126. My contact info is: 408-504-1558 (mobile) or natalia@nataliachang.com.

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(II) About My Private Practice

Sessions last 30-90 minutes, depending on the type of session/consultation you’ve elected to participate in. Intuitive healing sessions, vibrational essence consultations, Healing Touch, Reiki and BioMat are described in the “What to Expect” document. During your session I may combine on-body or near-body touch with energy healing. You may decline touch and/or energy healing at any time during any session you receive from me. You are encouraged to self-advocate regarding your touch and energy preferences. Vibrational essence consultations and BioMat do not use such as a healing technique. BioMat® is an FDA Approved Class II Medical Device and is ISO certified. I have read and agree to the safety precautions. Sessions are conducted with you fully clothed and seated, standing or lying down.

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(III) Education and Experience

I am a Healing Touch Certified Practitioner (HTCP) and Certified Reiki Master (CRM). I studied Bach Flower Remedies through the Bach Centre, UK and Alaskan Essences. My prior professional experience includes office and retail management, dance performance and instruction, natural childbirth and lactation education. I am not a licensed healthcare professional. You should discuss any recommendations made by me with your primary care physician, obstetrician, gynecologist, oncologist, pediatrician or other board-certified physician or licensed mental health care provider prior to implementing or following them.

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(IV) Regulation and Governance

The Healing Touch Program’s™ ethics committee governs issues and complaints related to my HTCP work. If you have an ethical concern as my client that you aren’t able to discuss directly with me, please call 210-497-5529. CA-SB-577 outlines your rights as a patient and my responsibilities as a complimentary and alternative healthcare provider in the state of California, the details of which can be found in the documents “California Senate Bill-577: What it Means for Patients” and “California Sent Bill-577 Compliance for Informed Consent”, copies of which are available on my website or in print.

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(V) Liability Insurance

I am covered by liability insurance, however you agree to receive the session described above at your own risk.

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(VII) Fee Schedule, Cancellation & Payment Policy

The fee for one session ranges from $30-$90 for vibrational essence consultations and $90-120 for energetic healing sessions, depending on the appointment type and duration. Reduced rates may be available – please ask if you need accommodation to afford your sessions. Payment is due at time of service. If you cancel with less than 24 hours notice, you agree to pay for the session in full. Please cancel/reschedule the link included in your appointment confirmation email or by phone call or text message to 408-504-1558, not by standard email.

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(VIII) Confidentiality

Your sessions and documentation are confidential. Confidentiality exceptions will be made only if legally required, such as under a court order or if you indicate you’re harming or intend to harm yourself or others or with your express and written permission.

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(IX) Consent for Treatment & Liability Waiver - Sign below if you understand & agree with ALL of the following:

I consent to receive the treatment described above and in any conversations I may have had with Natalia Ronstadt Chang prior to signing. I agree to the terms and conditions described above. I understand that all forms of energetic healing and vibrational essences are not substitutes for licensed care. No guarantees have been made to me regarding cures or improvements. I have read this document carefully and have received a copy. I have felt free to ask questions and if I have asked questions, the answers have been satisfactorily explained to me. I understand that I am free to withdraw this document in writing and/or discontinue sessions at any time. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Natalia Ronstadt Chang and her representatives and/or beneficiaries from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s) or consultation(s) or from treatment with vibrational essences. I agree that if any statement or part of this document is found to be unenforceable the rest shall remain intact and enforceable.

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Signature *

ELECTRONIC SIGNATURE: I have reviewed this document and fully understand and agree to its contents. I understand that this form is not a secure HIPAA document and that signing this form is voluntary. I agree to submit this form electronically. I verify that I am the person whose name appears below and agree that my signature below is the legal equivalent to a manual signature on a document. My typed signature below, along with my submission of this electronic document signifies that I have read, understand, and agree to the terms and conditions herein.

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