Pathway To Somatic Healing, Inc.
Client Disclosure Form ( according to California Senate Bill SB-577):
The Founder of Pathway To Somatic Healing, Inc., Stephen Sova is a Holistic Health Practitioner and Somatic Practitioner who uses a holistic approach when working with clients.
He has the following training and credentials:
1997 Pacific College Of oriental medicine, San Diego, CA
Holistic Health Practitioner (HHP) and Oriental Bodywork Therapist (OBT) certifications
2001 Biodynamic Craniosacral Therapy Training: 650 hirs completed
2001: Somatic Experiencing Practitioner Certification (SEP)
2001-02008 Somatic Experiencing Trauma Institute: Assistant in Trauma training Programs
2008-Present: Ongoing training in intuitive awareness with Henrike Duerre (Heilpraktiker & Intuitive counselor), Germany.
To provide Pathway To Somatic Healing Inc. sessions or consultations, the following is disclosed:
* Pathway To Somatic Healing, Inc. is not a licensed physician, psychologist, counselor, or facility and as such is not licensed by the state of California. Stephen Sova does not diagnose or prescribe for any condition that you might have, and he does not make any specific claims regarding results from the session(s) you receive. If you need one of these other providers please ask for a referral.
* Pathway To Somatic healing Inc. is alternative or complementary to healing art businesses that are licensed by the state of California.
* The nature of the services rendered is a somatic based approach evolved by Stephen A. Sova over the last decade.
*There are numerous benefits possible with the use of complementary & alternative healing modalities and these effects might vary depending upon each individual
* Many clients experience positive mental, emotional, or physical changes as a result of their own ability to grow and transform into a new place with themselves and others.
* clients are completely in charge of their own experience during a session and they are encouraged to express themselves regarding anything that may come up. Clients are encouraged to give feedback should anything feel uncomfortable or inappropriate, or if they have questions about any part of their treatment.
* A session with Pathway To Somatic healing Inc. is not intended to replace any currently prescribed medical treatments as ordered by your physician nor any other medical care you have or may be advised to seek. It is recommended for you to consult a licensed medical practitioner or psychologist for any physical or mental conditions you have.
* The theory upon which Pathway To Somatic, Inc. was founded is derived from several years of study of the above stated alternative healing arts ( see training section) and Stephen Sova's personal healing path, which taught him that physical and emotional pain patterns can be improved by deeply connecting and listening to one's inner experiences and connecting back to resources which bring joy and balance to one's life.
* All client information and records are treated in a confidential manner. Your experiences during these sessions are confidential and may not be released to individuals or agencies without your signed consent, except in cases when it is subject to the usual exceptions governed by the State or Federal laws and regulations, such as the threat of serious harm to self and others. Records will be held for 3 years after your last appointment date. You will be given a copy of this form for your own records.
* Insurance is not accepted at this time, but session fees may be paid through cash, check, or by credit card. Fees are due at the time of the session and are as follows:
Minimum Session 40 minutes $ 133
Hourly Rate $ 200
Anytime over the 40 minutes will be billed at the hourly rate of $200
A twenty-four (24) hour cancellation of your appointment is required. You will be charged for the entire session fee for any missed appointments.
* I have read this disclosure form and have discussed with Pathway To Somatic Healing, Inc. the nature of the services provided. I understand and agree to the policies described herein. I fully consent to use the services offered by Pathway To Somatic healing, Inc.
______________________________________________Client Signature _________________ Date
Client Disclosure Form ( according to California Senate Bill SB-577):
The Founder of Pathway To Somatic Healing, Inc., Stephen Sova is a Holistic Health Practitioner and Somatic Practitioner who uses a holistic approach when working with clients.
He has the following training and credentials:
1997 Pacific College Of oriental medicine, San Diego, CA
Holistic Health Practitioner (HHP) and Oriental Bodywork Therapist (OBT) certifications
2001 Biodynamic Craniosacral Therapy Training: 650 hirs completed
2001: Somatic Experiencing Practitioner Certification (SEP)
2001-02008 Somatic Experiencing Trauma Institute: Assistant in Trauma training Programs
2008-Present: Ongoing training in intuitive awareness with Henrike Duerre (Heilpraktiker & Intuitive counselor), Germany.
To provide Pathway To Somatic Healing Inc. sessions or consultations, the following is disclosed:
* Pathway To Somatic Healing, Inc. is not a licensed physician, psychologist, counselor, or facility and as such is not licensed by the state of California. Stephen Sova does not diagnose or prescribe for any condition that you might have, and he does not make any specific claims regarding results from the session(s) you receive. If you need one of these other providers please ask for a referral.
* Pathway To Somatic healing Inc. is alternative or complementary to healing art businesses that are licensed by the state of California.
* The nature of the services rendered is a somatic based approach evolved by Stephen A. Sova over the last decade.
*There are numerous benefits possible with the use of complementary & alternative healing modalities and these effects might vary depending upon each individual
* Many clients experience positive mental, emotional, or physical changes as a result of their own ability to grow and transform into a new place with themselves and others.
* clients are completely in charge of their own experience during a session and they are encouraged to express themselves regarding anything that may come up. Clients are encouraged to give feedback should anything feel uncomfortable or inappropriate, or if they have questions about any part of their treatment.
* A session with Pathway To Somatic healing Inc. is not intended to replace any currently prescribed medical treatments as ordered by your physician nor any other medical care you have or may be advised to seek. It is recommended for you to consult a licensed medical practitioner or psychologist for any physical or mental conditions you have.
* The theory upon which Pathway To Somatic, Inc. was founded is derived from several years of study of the above stated alternative healing arts ( see training section) and Stephen Sova's personal healing path, which taught him that physical and emotional pain patterns can be improved by deeply connecting and listening to one's inner experiences and connecting back to resources which bring joy and balance to one's life.
* All client information and records are treated in a confidential manner. Your experiences during these sessions are confidential and may not be released to individuals or agencies without your signed consent, except in cases when it is subject to the usual exceptions governed by the State or Federal laws and regulations, such as the threat of serious harm to self and others. Records will be held for 3 years after your last appointment date. You will be given a copy of this form for your own records.
* Insurance is not accepted at this time, but session fees may be paid through cash, check, or by credit card. Fees are due at the time of the session and are as follows:
Minimum Session 40 minutes $ 133
Hourly Rate $ 200
Anytime over the 40 minutes will be billed at the hourly rate of $200
A twenty-four (24) hour cancellation of your appointment is required. You will be charged for the entire session fee for any missed appointments.
* I have read this disclosure form and have discussed with Pathway To Somatic Healing, Inc. the nature of the services provided. I understand and agree to the policies described herein. I fully consent to use the services offered by Pathway To Somatic healing, Inc.
______________________________________________Client Signature _________________ Date