Individual form

(Please read the following information and sign the form.)

Informed Consent

Welcome to Roland Bérard’s practice. This document contains important information about his approach and policies. Please read it carefully and note any questions you would like to discuss with him. Then sign at the bottom of the page to indicate that you agree with the content.

1. Nature of services

The services offered by Roland Bérard are exclusively focused on prevention and overall well-being.

They consist of informing, educating, and supporting clients in adopting lifestyle habits that promote balance and vitality, including through: Energy work (Reiki and Brennan Healing Science), Hakomi therapy, EFT, Core Energetics, and Fasciatherapy.

These services are non-medical in nature and are in no way intended to diagnose, treat, prescribe, correct, or cure any disease, disorder, or physical or psychological condition.

Roland Bérard does not perform any acts reserved for healthcare professionals, does not conduct any clinical evaluations, and does not interpret medical results.

Anyone with symptoms, a medical diagnosis, or a health condition requiring evaluation or treatment should consult a physician or other qualified healthcare professional.

2. Professional distinction

You acknowledge that Roland Bérard is not a physician, psychotherapist, psychologist, dietitian, nutritionist, pharmacist, or member of a professional health association, and that he/she is not authorized to perform acts reserved for physicians or any other professional health association.

You also acknowledge that her interventions do not constitute and do not replace a diagnosis, prescription, treatment, or medical follow-up.

The services offered are exclusively educational and preventive in nature and are intended to promote general well-being.

3. Information collected

During the sessions, you may be asked to provide information about your lifestyle, diet, energy level, discomforts or known medical conditions, as well as any medication or products you are taking.

This information is used solely to:

1. i) Better understand your lifestyle
2. ii) Offer tailored wellness suggestions, and

iii) Promote the adoption of healthy habits

All information collected remains confidential and will not be disclosed without your consent, unless required by law.

4. Limits of practice

If Roland Bérard suspects a health problem that requires medical evaluation, he will inform you and recommend that you consult a doctor.

No changes to medication, dosage, or prescription should be made without consulting the professional who prescribed it.

4. Client responsibility

You acknowledge that Roland Bérard’s recommendations are intended to improve your overall well-being and that their application is your own responsibility.

You understand that it is your responsibility to disclose any known health conditions and to consult a physician for any symptoms or concerns.

5. Disclaimer

You acknowledge that you assume full responsibility for your participation in the wellness recommendations and release Roland Bérard from any liability for any adverse reactions or consequences resulting from the application of the advice received.

You understand that Roland Bérard may refuse or discontinue follow-up if the situation exceeds his scope of practice.

6. Approach

Roland Bérard’s approach is holistic, and he considers you to be a complex, dynamic, and unique being—body and mind—acting as a facilitator in your personal process.

His approach is to work with the body and the energy field, as well as the consciousness associated with imbalances. He works directly with the energy field and through the body to encourage your self-discovery and to identify what prevents you from fully enjoying life and being in your pure essence. The work is collaborative and requires a commitment on your part to be curious and to study yourself as you work together.

The technique of energy work through the laying on of hands balances and recharges your energy field and the accumulations that can eventually turn into discomfort and illness. This work increases your body’s potential for self-healing. Roland Bérard works by laying his hands on your body through touch, with your permission, or by working on your energy field above the body. He sometimes uses voice vibrations to dissolve these accumulations. If at any time you feel uncomfortable, it is your responsibility to let him know. Taking care of yourself is a very important part of your process of returning to wellness.

Be aware that this work may bring up strong emotions. Due to the nature of this work, please do not come under the influence of alcohol and do not consume alcohol within 24 hours of the session.

The support work aims to help you study yourself and thus create nourishing experiences to create new possibilities in your life.

7. Confidentiality

Everything you share is confidential. However, Roland Bérard sometimes discusses his clients (without identifying them) with his supervisor or colleagues to further his professional development and help him serve you better.

Confidentiality will be respected unless otherwise required by the law.

8. Telephone and email

Roland Bérard tries to answer his calls as soon as he is available.

The telephone and email are not the best ways to deal with the issues or emotions that may arise during a session. All correspondence and calls from you are considered sacred. Roland Bérard will read the emails you send him, but will not necessarily respond to them.

Please be aware that emails are not confidential and may be intercepted on the internet. Roland Bérard cannot be held responsible if the information contained in email exchanges becomes public.

9. Provisions relating to the Personal Information Protection Act (Bill 68)

You have provided us with information relating to your personal file. Following the coming into force of Bill 68, and unless you indicate otherwise, it is considered that you consent to all information that you have provided or will provide verbally or in writing being recorded in a file. Furthermore, unless you notify Roland Bérard otherwise by registered letter, your consent will be considered valid for a period of five (5) years.

10. Recording of sessions

It is prohibited to record sessions on video or other media.

Questions

All my questions have been answered to my satisfaction.

I agree to allow Roland Bérard to do a reading of my energy field remotely before the session.

You also acknowledge that you have presented yourself under your real name, in good faith and for no other reason than natural healing.

 

Cancellation of an Appointment
Please provide at least 24 hours’ notice (preferably 48 hours) in advance if you need to change or cancel your appointment. Otherwise, the full payment for the session will be required and must be paid before scheduling the next session. In cases where illness or severe weather makes travel dangerous, it is always possible to work remotely via telephone or Skype.

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Late Arrivals
If you arrive late for your appointment, we will use the remaining time; however, the full payment for the session will still be required.

The first session lasts approximately one hour (1h), and subsequent sessions are 50 minutes. If you believe you need more time, it is possible to schedule a longer appointment in advance, and the cost will be adjusted accordingly.

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Payments
Payments are due at the end of each session and can be made at the office by check or cash. Payments can also be made in advance through my website using Interac or PayPal.

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Returned Checks
A fee of $15 applies to checks returned by your financial institution.

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Consent and Limits of My Practice
I have read and understood the information presented here by Roland Bérard. I also understand that his services do not constitute psychotherapy, a medical examination, diagnosis, or a substitute for medical treatment, and nothing said during the session should be interpreted as such. All my questions have been answered to my satisfaction.

I agree that Mr. Bérard will read my energy field remotely before the treatments. The client acknowledges that he presented himself under his real name, in good faith and for no other reason than that of natural therapy care.