Client's Bill of Rights

Client's Bill of Rights (a)

Clients Bill of Rights and Waiver Form

Sky Blue Shiatsu  3947 Excelsior Blvd. St. Louis Park, MN 55416 phone: 612-929-5583

Shiatsu is a clothes-on Japanese style of Asian Bodywork Therapy based on Traditional Chinese Medicine (TCM) and Western Anatomy and Physiology. Techniques include pressing with palms and fingers, kneading, tapping, stretching, and range of motion exercises. The goal is to promote the flow of "Chi" or energy in the body, relax the muscles, and restore a feeling of well being.

Jill Alleyne, B.A., M.A., AOBTA Certified Asian Bodywork Therapist of Shiatsu since 1997. ACE and SS&C Cert. Personal Trainer and Post-rehab Exercise Specialist since 2004. My theoretical approach is to help people find the best way to deal with stress, physical pain and weakness, and limited mobility. I draw on my varied 25 year background and training in internal martial arts, movement and dance training, Qi Gong, Reiki, personal training, group exercise and post-rehab exercise therapy.  

Kelly Sanches, B.A., Diplomate of Asian Bodywork Therapy NCCAOM, AOBTA Certified Practitioner since 1997. My theoretical  approach is to help clients to be more present in their bodies.  I provide a safe and nurturing environment.  I use gentle techniques, along with a traditional Asian medical approach to help clients with choices regarding diet, exercise and relaxation, along with meridian stretching.

 We both attended the Minnesota Center for Shiatsu Study's 500 hour program in 1996, and are current AOBTA (American Organization of Bodywork Therapies of Asia) members. We carry professional and liability insurance, and have current CPR training. Jill and Kelly both have continuing training in Therapeutic Bodywork Techniques, and Jill for Personal Training, and Post-rehab Exercise.

“The state of Minnesota has not adopted any educational and training standards for unlicensed complementary and alternative health care practitioners.  This statement of credentials is for information purposes only. Under Minnesota law, an unlicensed complementary and alternative health care practitioner may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments.  If a client desires a diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or services from a physician, chiropractor, nurse, osteopath, physical therapist, dietitian, nutritionist, acupuncture practitioner, athletic trainer, or any other type of health care provider, the client may seek such services at any time.”

If you have any complaints please let us know and we will do our best to resolve them, or you may contact the MN Department of Health to file an official complaint:

Minnesota Department of Health, Health Occupations Program
Susan Winkelman,  (651) 282-6366
PO Box 64975, St Paul, MN55164
www.revisor.leg.state.mn.us/stats/146A001.html

Rates List

Rates

Current Rates  (add 7.525% state sales tax if applicable) 

 15 Minutes - $25.00

30 Minutes - $45.00

60 Minutes - $85.00

75 Minutes - $105.00

90 Minutes - $125.00

 On-site massage— please contact us with details about your event. (please add 7.525% state sales tax unless Dr’s note, no tax on personal training) We will give two weeks notice of any changes in services or fees. Payment of check or cash is due at time of service. Sorry we do not accept credit cards. We require 24 hours cancellation notice or full payment on all sessions. Your appointment time is reserved for you and cannot be refilled on short notice. Thanks for your consideration!

We will defer payment in cases of insurance reimbursement conditionally. Client must confirm that insurance will cover the sessions. We will provide receipts/charts, but client must bill insurance company directly. Client is responsible for full payment to practitioner. No discounts are allowed for insurance coverage, unless the sessions are prepaid. Client agrees to pay for any amount not covered by insurance.

Client's Bill of Rights (b)


Client Rights

You have a right to complete and current information regarding our assessment and treatment plan for you, including scope and duration.  Your client records and transactions are confidential, unless released by you in writing or otherwise provided by law.  You may have access to your records in accordance with section 144.335. You have the right to a coordinated transfer if there is a change in service provider.

Other services may be available in the community. We provide referrals upon request.  You may choose freely among available practitioners and may change service at any time within the limits of health insurance, medical assistance, or other health programs.

You may expect courteous treatment and to be free from verbal, physical, or sexual abuse by the practitioner.  You have the right to stop treatment at any time.  We encourage you to tell us if we are using too much pressure or not enough.  Your comfort is important to us.  You may refuse treatment and assert your rights without retaliation.

       (print name here)

I, ________________________________, have received the Complementary and Alternative Health Care Client Bill of Rights and understand the cancellation policy.  I understand that any treatments given are not intended to replace proper medical care from a physician or otherwise licensed healthcare practitioner.

  

SIGNATURE      X___________________________________  Date________________ 

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