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Gates group LLC
LAURA FRANCES GATES
EXECUTIVE COACHING, RETREATS & SPIRITUAL MENTORING
Last Updated July 6, 2017
Client Agreement & Disclosure Statement
Thank you for your interest in working with me as a client either in person or over the phone/Skype, whichever is applicable, for services. I am providing you with the following information so you can make an informed choice about your decision to engage my services. Please read this information carefully and let me know if there is any part you do not understand.
Although I will share my skills and abilities to support your growth, intuitive awareness, and tools for your personal and/or professional development, my work with you is only a resource. As an intentional and conscious participant in your growth, you will ultimately take all responsibility for and actions related to furthering the evolution of your life journey.
CLIENT INFORMATION SHEET
In September 2003, California passed ground breaking legislation (California Senate Bill SB-577) which has profound implications for the practice of complementary and alternative forms of health care in California. SB-577 legally enables complementary and alternative health care practitioners to provide and advertise their services to California citizens. However, they must comply with certain requirements specified within the bill which has now become part of California law under sections 2053.5 and 2053.6 of California’s Business and Professions Code.
Sections 2053.5 and 2053.6 of California’s Business and Professions Code provide the following:
A. Provide access to complementary and alternative health care practitioners. You must be given information about the nature of treatment and the practitioner’s qualifications. Please ask your practitioner any question you may have about the treatment options they offer. Ask if you practitioner has been certified by a professional organization and if they belong to any professional organizations. Please tell your physician if you are receiving any alternative treatments. You can also request that your licensed and unlicensed health care providers communicate with each other and work collaboratively to meet your health goals.
B. Requires unlicensed complementary and alternative health care providers to follow certain guidelines and to refrain from certain practices
C. Specifies that unlicensed complementary and alternative health care practitioners are NOT allowed to do:
- Perform any form of surgery or any procedure that punctures your skin or harmfully invades your body.
- Use X-ray radiation
- Prescribe prescription drugs, or recommending that you discontinue drugs that were prescribed by a licensed physician.
- Set fractures
- Treat wounds with electrotherapy
- Put you at risk of great bodily harm, serious physical or mental illness, or death
- Imply in any way that you are a licensed physician.
D. Specifies that complementary and alternative health care practitioners MUST DO the following things:
- Provide you with a statement, written in plain language that includes the following information: (1) that they are not a licensed physician and that their services are not license by the state; (2) a brief and clear description of the kind of services they provide and the reasoning behind it; and (3) a description of their education, training, and experience.
- Ask you to sign and acknowledge that you received the above written statement, and provide you with a copy of it. They must also keep a copy of your signed acknowledgment for three years.
Services Offered – Theoretical Approach
As a heart centered intuitive practitioner and Soul Purpose coach, my goal is to help you uncover your purpose and mission in life. The services I offer are designed to help you unlock your innate intelligence by tapping into the universe’s energetic frequencies to assist you in connecting with your deepest truth. In my practice I offer innovative energy-based coaching and self-help techniques combined with intuitive skills based on the newly emerging field of energy medicine (the “Energy Techniques”). Energy Techniques is a collective term used to refer to a variety of alternative and complementary treatments based on the use of intuitive skills and the use and modification of energy fields. The prevailing premise of the Energy Techniques is that the flow and balance of the body’s electromagnetic and more subtle energies are important for physical, spiritual, and emotional health, and for fostering well-being. Although the Energy Techniques appear to have promising emotional, spiritual, and physical health benefits, they have yet to be fully researched by the Western academic, medical, and psychological communities and therefore, may be considered experimental. The Energy Techniques are self-regulated and the State of California does not license any Energy Technique practitioners and considers the Energy Techniques to be alternative or complementary to the healing arts that are licensed by the State of California.
If you ever have questions or concerns about the nature of the theories and methods I use, please feel free to ask me for further resources or references.
Nature of the Relationship
I’m not a psychologist, psychotherapist, physician, or other licensed health care provider nor are my services licensed by the State of California. Under Sections 2053.5 and 2053.6 of California’s Business and Professions Code, I can offer you my services, subject to the requirements and restrictions that are described fully in the attached Client Information Sheet incorporated herein by reference and made part of this Client Agreement and Disclosure Statement. Please be advised the services I offer and the use of the Energy Techniques are not intended to be a substitute for medical or psychological treatment and they do not replace the services of health care professionals. You agree and understand it is your responsibility to consult with your health care provider for any specific health care problems.
Risks and Benefits
Please note that it is impossible to guarantee any specific results regarding your goals using the services I offer. However, we will work together to achieve the best possible results for you. Most clients have very positive outcomes using my services and report that they gain a deeper understanding about their life mission and purpose that benefits them in a myriad of ways. Please be advised however, that in using the Energy Techniques and intuitive coaching as part of our sessions together or on your own between sessions, it is possible to experience some emotional distress and/or physical discomfort that can be perceived as negative. Unresolved memories may also surface and emotional material may continue to surface after a coaching session and give indication of other issues or incidents that may need to be addressed. You agree to promptly inform me if you experience any emotional distress and/or physical discomfort during our work together, particularly between our sessions. If appropriate, I can help refer you to an appropriate professional health care provider for further assistance. Regardless of our work together, you agree to take full responsibility for your self-care in the emotional, mental, physical, and spiritual dimensions of your life.
Fees and Payments
Fees are negotiated per client agreement and are billed at time of booking and paid in full prior to the first session, payable through PayPal (which will provide you with an invoice for your records). If you prefer to pay by check let me know at time of booking.
Scheduling of appointments involves the reservation of time specifically for you. Therefore a minimum of 48 hour advance notice is required for rescheduling or canceling an appointment. The full fee or half fee may be charged for missed appointments without such notification.
Education and Training
I received a Masters Certification in Intuition Energy Medicine® (MIM) from the Academy of Intuition Medicine® in July, 2012. The Academy is approved by the State of California as an accredited postsecondary vocational training institution. I also have extensive training in numerous energy healing modalities as well as extensive coaching training, communication, and conflict resolution over the past 20 years of my executive coaching career. I am also an ICF PCC certified coach.
Acknowledgment and Consent to Receive Services
By signing this document you agree that I have disclosed to you sufficient information to enable you to decide to undergo or forgo using the Energy Techniques and other services I offer. You have considered all of the above information and have obtained whatever information or professional advice you deem necessary to make an informed decision. Further you understand I am offering my services solely as a coach and intuitive practitioner and our relationship is not to be construed as psychotherapy, psychological counseling, or any type of therapy, nor is it a substitute for these services. You understand that it is your responsibility to maintain a relationship with a health care professional.
You understand that your consent to the nature of our sessions is given voluntarily, without coercion, and may be withdrawn at any time in the future. You represent that you are competent and able to understand the nature and consequences of the proposed sessions and agree to be personally responsible for the fees related thereto. You have discussed with me the nature of the services to be provided and you understand that I’m not a licensed health care provider and that my services are not licensed by the State of California. By signing in the space provided below, you knowingly, voluntarily, and intelligently assume these risks and agree to release, indemnify, hold harmless and defend Laura Gates and her agents, representatives, consultants, and employees from and against any and all claims of whatsoever kind or nature, which you, or your representatives, may have for any loss, damage, or injury arising out of or in connection with your sessions.
In order to use my services, California state law requires that you acknowledge receipt of the information provided in this Client Agreement & Disclosure Statement. I will keep an original in my records for at least three (3) years.
Sign and date in the fields below.
Please note that by doing so you are electronically signing a legal binding agreement.
© 2012 Midge Murphy. All rights reserved. Any unauthorized use of this Client Agreement & Disclosure Statement is prohibited by federal law. No part of this document may be reproduced or transmitted in any form or by any means, including photocopying, for public and/or private use without permission in writing from Midge Murphy.