Please print, fill out, and email to pamelabloom@mac.com before your first session.

Soul in Bloom Holistic & Wellness Services – Informed Consent

Client Name: ___________________________________________________Date: __________

Practitioner: Pamela Bloom, Msc, Reiki Master & Licensed Pastoral Counselor
Website: www.SoulInBloom.net

1. Scope of Services
   I understand Pamela Bloom offers complementary holistic therapies (Reiki, guided meditation, energy healing) to promote relaxation, stress reduction, and mind–body–spirit balance. These services do not replace medical or mental‑health care, diagnosis, or medication.

2. Qualifications
   I acknowledge Pamela is a trained wellness practitioner—not a medical doctor, nurse, dietitian, or chiropractor—who does not diagnose or prescribe medication.

3. Risks & Benefits
   • Benefits may include reduced pain, emotional release, and greater well‑being.
   • I understand side effects are minimal (e.g., shifts in emotion or energy).
   • Reiki is not for injuries needing immediate medical attention.

4. Client Responsibilities
   • I will continue any prescribed medical care.
   • I’ll inform Pamela of health changes (pregnancy, new diagnosis).
   • For minors, a guardian must consent and remain present.

5. Touch Preferences
   ☐ Hands‑on treatment OK ☐ Hands‑above treatment OK

6. Emotional Safety
   I acknowledge that emotions may arise. For severe distress, I will seek licensed mental‑health support.

7. Confidentiality & Collaboration
   Pamela may consult with my healthcare providers only with my permission.

8. Cancellation Policy
   Cancellations ≥24 hrs ahead incur no fee;;less than 4 hrs incur full session fee.

By signing, I consent to holistic treatment, understand its nature, and release Pamela Bloom from liability. I may stop sessions at any time.

Client/Guardian Signature: __________________________________________________________

Practitioner Signature: ______________________________________________________________

Date_____________________________________________________________________________________