New Client Request Form

This checklist is designed to assist you in the steps required prior to your first phone call with a practitioner. This form will take about 10 minutes to complete.

For questions related to session billing, please contact the HS Financial Administrator:

Penny Vier : Office: (651) 755-4569

Email: penny@besthealingsolutions.com

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Healing Solutions Session Request Form

(Completion required once)

Contact Information

(Email information is used for monthly statements only.)

(It is beneficial for us to have a photo of the person receiving a session)

History Questionnaire

Legal and Financial Understanding

 
Most issues, such as those involving pain, trauma, and emotion, respond immediately to bioenergetic correction with Healing Solutions. More complex issues involving autoimmune process or chronic illness with pathological tissue and biological agents take longer to resolve. An example would be a person with a massive fungal infection and gut dysbiosis with hidden virus and parasites. This client may need to avoid certain foods and may need to take a supplement or two to help kill off the fungus, virus and parasites along with the HS code. It may take the body time to kill off the pathogens and rebuild the gut lining.
 
Due to the nature of Healing Solutions, LLC and its high effectiveness, we make the following guarantee:
 
We will evaluate and suggest a bioenergetic correction for your issue and let you experience the results overnight. If you do not believe, after overnight reflection, that you are dramatically better or that your chronic condition will benefit greatly from this work, we will fully refund your initial payment of fees. This is a one-time guarantee, and you must make this determination within 24 hours of your first session. If you choose to continue sessions, no refund will be available. If you choose to request a refund, there will be no additional sessions provided to you in the future.

Disclaimer, Hold Harmless, and Consent to Participate in Energy Coaching Sessions with a Healing Solutions Practitioner

 

Disclaimer Overview

Healing Solutions (HS) is not intended to diagnose, prescribe, treat, or cure any disease, physical or mental. The use of Healing Solutions (HS) by an HS practitioner should not be construed as a prescription, a promise of benefits, claims of cures, or a guarantee of results to be achieved. The information, instruction or advice given by a Healing Solutions practitioner is not intended to be a substitute for competent professional medical or psychological diagnosis and care. You should not discontinue or modify any medication presently being taken pursuant to medical advice without obtaining approval from your healthcare professional. As a Healing Solutions client, you must take complete responsibility for your own physical health and emotional wellbeing.

Disclaimer Explained

Healing Solutions consists of self-help coaching techniques and tools, within the category of “energy therapy.” A client learns and uses Healing Solutions to balance their own body’s energy system with the intention of reducing stress, enhancing overall health, and removing dysfunctions in the body's bioenergetic system. Healing Solutions and its practitioners believe that it is the client who heals themselves, and that the Healing Solutions techniques and tools simply assist the client in this process. Every Healing Solutions client is unique, and therefore, each client’s experience with Healing Solutions may be unique. Healing Solutions is not a substitute for regular medical or psychological care. Healing Solutions is not about disease or illness - rather, its focus is on healing and wellness. Medical authorities do not recognize this work as “medicine”. We agree. There are researchers in this area who believe there is a correlation between the detection of certain energetic frequencies and the presence of disease states or organisms in the body. Energy therapies, like Healing Solutions, may be able to identify the unhealthy frequencies years before a physical disease manifests in the body. As a person heals those frequencies, health is enhanced. Our work, which includes evaluations and scans of the subtle-energy field, is strictly limited to address the imbalances in the subtle-energy field. For example, in our scans we may talk about the frequencies of virus, bacteria, fungus and parasite issues. We are only saying that we have often found those frequencies when our clients are in a non-healing state. Commonly, people who manifest those frequencies over time experience patterns of deterioration in the way they feel. As those frequencies are cleared and the energy field is balanced, they typically experience a return to feelings of wellness. We cannot determine if the client actually had a virus, bacteria, fungal infection or parasite. We cannot determine if a client actually has Multiple Sclerosis, Parkinson’s disease, Manic Depression or HIV, for example. Testing for that is beyond our expertise. For those determinations, we refer clients to their M.D. or licensed health care professional for appropriate tests. No one is advised to discontinue or to avoid medical or psychological consultations. There are cases where medical or psychotherapeutic consultations are advised. Don’t use these techniques to try to solve a problem where your common sense would tell you it is inappropriate. Since these are self-treatment techniques, we cannot and will not take responsibility for what you do with them. You are required to take complete responsibility for your own well-being both during and after the use of our materials and/or coaching sessions. Some statements on web site, https://www.besthealingsolutions.com, manuals and products represent working theory rather than accepted science. Healing Solutions practitioners practice as bioenergetic consultants, not as licensed medical doctors, psychologists, psychotherapists, chiropractors, lawyers, nutritionists, or naturopaths. Although these techniques are being used by therapists, health professionals and lay people worldwide, the practice of Healing Solutions and bioenergetic consulting is not currently regulated by any licensing board in the United States. Any spiritual counseling provided by Healing Solutions practitioners is not part of any recognized religion. We have not personally experienced any adverse side effects when applying the gentle techniques of Healing Solutions when the treatment protocols and suggestions were followed. This does not mean, however, that you will not experience or perceive negative side effects. If you use these techniques on yourself or others, you must agree to take full responsibility for your own well-being and you are required to advise others to do the same. You must understand that while an energy healing approach is a safe self-treatment method, with a substantial body of clinical experience showing no serious side-effects when properly administered, it is possible, with any form of healing, that unresolved memories and related emotions and sensations may be brought into your awareness. It is possible that this emotional material may continue to surface after the coaching session and require further self-treatments or coaching sessions. It is also possible that previously traumatic memories may lose their emotional charge, and this could adversely affect your ability to provide legal testimony that carries the same impact as it might have prior to treatment. In some rare cases, clients with chronic illness have reported some mild healing reaction symptoms as their body releases stored toxins. Typically this is short lived and can be addressed with another coaching session or self-treatment protocol.

Hold Harmless Agreement

I agree to hold harmless Beth Daniel Jones, the originator of Healing Solutions, LLC, and it's practitioners, and anyone affiliated with Healing Solutions, LLC, from any claims, liability, or loss incurred directly or indirectly by me (or anyone I may teach or seek to help using Healing Solutions) as a result of the use or application of any techniques or methods learned from a Healing Solutions practitioner or product.

PAYMENT INFORMATION

Bioenergetic correction is not typically a health insurance reimbursable item. Some medical savings plans do allow for these services if they are billed as acupressure for allergies or pain control.

Bill my credit or debit card for the session(s) I received. I accept that it is my responsibility to keep track of the time I use or ask the Practitioner how much time I have used at the end of each session.

If you have a session with a practitioner, then an invoice will be incurred and your credit card will be charged at the end of the bi-monthly billing period during which your session occurred. You are not billed if you do not have a session with a practitioner.
If billing address is different, please enter that information below, if not, please disregard this section.

Client Request and Authorization

Please type your name in the field above, this serves as your signature and acknowledgement of the agreement.