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    • SERVICES
    • MISSION & FAQs
    • CONTACT US & ABOUT US
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    • IN THE NEWS!
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    • FORMS & TERMS OF SERVICE
    • Blog
  • HOME
  • SERVICES
  • MISSION & FAQs
  • CONTACT US & ABOUT US
  • TESTIMONIALS & REVIEWS
  • ORDER CDS AND CD REVIEWS
  • IN THE NEWS!
  • EVENTS
  • FORMS & TERMS OF SERVICE
  • Blog
Healing Notes

Energy Healing Music Therapy Social Work Light Coaching Emotion/Body Code

Energy Healing Music Therapy Social Work Light Coaching Emotion/Body CodeEnergy Healing Music Therapy Social Work Light Coaching Emotion/Body CodeEnergy Healing Music Therapy Social Work Light Coaching Emotion/Body Code

NEW CLIENT INTAKE FORM

Agreements between the provider and client make our relationship more professional and clarified. 


Please fill out the on line form & let us know how we can help you!

click here for intake form

NEW CLIENT AGREEMENT/RATE FORM

The provider will complete this form and send it to the client or the representative to sign before services are rendered

client agreement/rate form

Terms of Service, Payment,Cancellations, HIPAA, Disclaimer

The Terms of Service take effect when clients calls and/or books an appointment.

Agreements between the provider and client make our relationship more professional and clarified.

  1. The client is responsible for making known to the practitioner any preexisting conditions that may affect treatment (e.g., eating disorder, psychiatric history). 
  2. The terms of service are subject to change and will be discussed if needed. Within reason, the provider and client or the representative will give as much advance notice as possible, excluding extenuating circumstances, if there is a change in the schedule or terms of service. See the cancellation policy below for more information.
  3. The provider maintains professional liability insurance and is in good standing with licensure requirements.
  4. The provider ensures that she is in good health. Likewise, the client and anyone in the home is free of contagious or communicable diseases to the best of their knowledge and will immediately report any changes in health status to the provider. If information is willfully withheld from the provider and is later discovered, the client or his or her representative will be responsible for any medical and related expenses due to temporary or longer disability of the provider.
  5. The client will be ready for services when the provider arrives or calls or signs on to Zoom or any other venue for providing services. If the client is not ready within a reasonable amount of time (i.e., 5-10 minutes), the provider will count the waiting time as part of the session time. See the cancellation policy below.
  6. Terms of Service may be subject to change according to the needs of the times and other circumstances.
  7. While we service multicultural populations and people of all faiths, we reserve the right to accept or decline clients if it's not a good fit, including multiple missed appointments or offensive behaviors.
  8. See below for payment and cancellation policies.
  9. Shoshana Averbach is licensed to practice social work and music therapy for clients who live in New York only. If a client or individual who is not a client and lives outside of New York and wants advice or advice was given unofficially as a gesture of goodwill and concern, the licensure laws do not apply to goodwill gestures.
  10. The professional licenses of social work and music therapy/creative arts therapy held by Shoshana Averbach are separate from any other services such as light coaching, Body/Emotion Code, etc.


The following terms apply to home or facility visits in addition to the above terms:

  1. The client or representative must provide a clean and safe working environment, e.g., free of bedbugs, vermin, and malodors such as cigarette or any other type of smoke or the like. 
  2. Stairs and entry ways must be passable and accessible. In case of injury to the provider, Gd forbid, the client or representative will cover unreimbursed expenses for medical and mental health services and possibly other related expenses. 
  3. The client or representative will also provide a clean and safe space in which to work such as a table and chairs. The client will allow the provider to use the bathroom and wash her hands.  
  4. The provider does not perform personal care duties like toileting, feeding, handing medication to the client, housekeeping, moving furniture, and the like. The provider may agree to moving a chair or light items in order to provide a working space.
  5. If the provider needs to assist the client with ambulation or seating in a chair, the client must use any assistive devices such as a cane or walker and the provider is not responsible for any falls nor injury to the client.  
  6. When applicable and possible, the provider would appreciate parking in a driveway or other safe area in proximity or pay for parking fees. If the provider takes a taxi or public transportation, the client will pay for travel expenses. 
  7. If another person is in the home or facility in the case of a home/facility visit, including home health aides and family members, s/he will remain on the premises during the session time or arrange for coverage unless the provider agrees.

PAYMENTS & CANCELLATION POLICY

PAYMENT

Payment is expected at the time of the session. We accept cash, checks, and PayPal. The client or representative will pay any fees for insufficient funds checks or service charges by other payment methods. The client will be charged for a full session if s/he decides to end the session early.


PACKAGES must be used within 1 year of purchase.


Insurance: Through Headway.co, we may accept Cigna for music therapy services for clients who live in New York State only. Otherwise, our services are private pay.


LATENESS/CANCELLATION/RESCHEDULING POLICY

LATENESS

The client will be ready for services when the provider arrives or calls or signs on to Zoom or any other venue for providing services. If the client is not ready within a reasonable amount of time (i.e., 5-10 minutes), the provider will count the waiting time as part of the session time. 


CANCELLATION/RESCHEDULING

In case of inclement weather, public health emergency or unforeseen events such as medical or family emergency or truly not feeling well, the client and provider will make an effort to reschedule the session(s) in the same week or a reasonable amount of time shortly afterwards (e.g., 1 week).


The client or representative is responsible for payment if s/he cancels within 48 hours or less of the scheduled session time and it cannot be rescheduled within the same week. 


An appointment is a commitment of time and money; it was set aside for the client and could have been used for another client to get help and to avoid a loss of income for the practitioner. So, we ask you to be mindful and responsible.

HIPAA (patient confidentiality laws)

In accordance with HIPAA regulations, we use HIPAA-compliant ZoomPro for remote sessions. If the client does not have access to Zoom, we may use the phone in an area that is private or as private as possible for remote sessions and cannot guarantee HIPAA compliance.

Please also note the following viz. HIPAA compliance:

1) The provider is not required to disclose any personal health information such as vaccine status, health conditions, and the like. (The provider ensures that she is in good health to the best of her knowledge.)

2) The provider, however, may ask for the patient's diagnosis or diagnoses and other physical and mental health history in order to provide appropriate interventions and services

3) We may ask for this information also in order to obtain payment for services from insurance or other venue which is allowable by law

4) Except if the client is in danger of harming him/herself or someone else, G-d forbid, we do not discuss patient information with anyone unless we have obtained verbal or written permission of the client or authorized persons such as the legal representative, health care proxy, and the like. If the client is in danger of harming him/herself or the clinician, we will contact EMS and/or other providers to ensure safety for all and will need to disclose the client's identifying information

5) We cannot guarantee confidentiality in transmitting texts, emails, or other electronic venues, so we advise clients not to communicate anything of a sensitive nature electronically.

DISCLAIMER STATEMENT

Music therapy, energy healing and balancing, The Emotion Code, The Body Code and any other services provided by healingnotes.com/Shoshana Averbach may remove or reduce energetic vibrations of traumas, trapped emotions, blockages, negative energies, and imbalances to promote healing for physical and emotional maladies. Muscle testing and intuitive inquiry may check what the subconscious mind and/or spirit reveals (i.e., the need for a certain food or nutrient), and these are intended as suggestions only. The suggestions are based on what the subconscious mind or spirit communicates by using muscle testing and, in some cases, intuitive inquiry, and the suggestions are not intended to be given as professional advice. Clients consent to muscle checking and intuitive inquiry as part of the session. 


Clients understand that uncomfortable feelings and past recollections may arise as part of the session for the purposes of clearing the imbalances and maladies. Resolution or amelioration of symptoms is not guaranteed and clients should seek further assistance with their medical/mental-health providers. The practitioner is not held liable for preexisting conditions getting worse while practicing in good faith. 


The client is responsible for following up about those suggestions with a professional. Sessions may also complement treatment for physical and mental health conditions that are provided by another licensed medical or mental health provider, nutritionist, etc. HOWEVER, they are not intended as a form of diagnosis and treatment nor cure that a licensed medical or mental health professional would provide and is NOT a substitute for medical care, nutritional advice, nor mental-health services and anything that is outside the scope of practice of HealingNotes/Shoshana Averbach as a social worker, music therapist, case manager, practitioner of the Body/Emotion Code, etc. 


Any suggestions that are given are for that particular modality (e.g., The Emotion Code) and are not a part of any other professional license held by the practitioner. (Example: Body Code sessions are separate from the practitioner's other credentials and professional licenses unless the practitioner is using the Body Code as a treatment modality while providing and billing services as a social worker within her scope of practice.) 


The Terms of Service are clearly stated on the website and take effect when the client books an appointment. 


NOTE: Our services may complement treatment for medical and emotional issues and are not a substitute nor are intended to diagnose any medical and psychological conditions nor offer any substitute for treatment.


Copyright © 2022 Healing Notes - All Rights Reserved.

  • HOME
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  • MISSION & FAQs
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