On June 5, 2013, the Colorado Legislature passed the Colorado Natural Health Consumer Protection Act (SB13-215). This legislation gives natural healing practitioners the right to practice in Colorado. The purpose of this legislation is to give all natural health practitioners who are not licensed by the State of Colorado the legal right to practice provided they disclose specific information to the client. Natural health practitioners include those practitioners providing alternative and complementary health care services charging a fee. Energy healing is such a service.

Below is a copy of a Disclosure Statement that you will be asked to sign at your first session. As required by law, a copy of this Statement is given to all new clients and Bonnie is required to keep a copy for two years.

DISCLOSURE STATEMENT
AS REQUIRED UNDER SB-215 FOR
COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS
IN COLORADO

 Practitioner Name:                 Bonnie Rickles

Practitioner Address:              7400 W. Jefferson Parkway, #109Lakewood, CO 80235

Practitioner Phone No.:           720-212-7301

As a Complementary and Alternative Health Care Practitioner, I am not licensed, certified or registered by the State of Colorado as a health care professional. I am not a licensed medical physician and do not diagnose, treat or prescribe remedies for the treatment of disease. The services I perform, whether in person, my mail or by phone, are at all times, restricted to complementary and alternative health care services intended for the maintenance of the best possible state of nutritional heath. I am prohibited from performing surgery or any invasive procedure, administer or prescribe x-ray radiation, prescribe prescription drugs, use general or spinal anesthetics, administer ionizing radioactive substances, use a laser device that punctures and skin, perform enemas/colonics unless board certified, practice midwifery, practice psychotherapy, perform spinal manipulation, practice optometry, directly administer medical protocols to a pregnant woman or a person who has cancer, practice dentistry, set fractures, practice massage therapy, provide a conventional medical disease diagnosis or recommend the discontinuation of a course of care recommended by a health care professional. I am also prohibited from treating children less than two years of age. In order to treat a child who is between 2-8 years of age, I must have a written, signed consent of the child’s parent or legal guardian.

______________________                            _________________________________
Name of Child (Age 2-8)                                    Signature of Parent/Legal Guardian

The services I provide are as follows: Reiki, Karuna Healing, Hands on Healing, Harmonics (Sound), Body Harmony,

My professional degrees, training, experience, credentials and qualifications are as follows:

• Hands on Healing Practitioner, 2014 (through Inner Insight Institute)
• Provide Reiki Sessions to people who have cancer through LifeSpark Cancer Resources, 2004-to present
• Provided over 100 hours of Hands-on-Healing sessions to the public as part of Hands-on-Healing training program in Denver, 2012 to 2014
• Certified, Karuna Master/Teacher, 2002 (Co-taught Karuna Healing from 2002 to 2006)
• Certified, Reiki Master/Teacher, 2000
• Body Harmony, 1995 (Practitioner through the Southern California Body Harmony Institute. The training consisted of completing 100 hours of Body Harmony classes and demonstrating the Body Harmony Touch with focus on the ability to listen to the body/tissues while working.)
• Sound Healing, 1994 (using voice – harmonics)

I do carry liability insurance applicable to any injury caused by an act or omission in providing complementary and alternative health care services.

A copy of this disclosure statement will be kept on file for at least two years after the last date of service.

As my client, you should discuss any recommendations I provide with your Primary Care Physician, Obstetrician, Gynecologist, Oncologist, Cardiologist, Pediatrician or Pediatric Health Care provider, or other Board Certified Physician.

_____________________                          _____________________________
   Name of Client (Print)                                            Signature of Client

_____________________                           _____________________________          
Address of Client (Print)                                     City, State, Zip Code (Print)

_____________________                            _____________________________         
Phone Number of Client                                       E-Mail Address of Client

_____________________                            _____________________________      
Date of Birth                                                          Date of First Visit