Complementary & Alternative Health Care Client Bill of Rights
Practitioner Name: Vicky Plante
Business Name: Restorative Healing, L.L.C.
Business Address: 8337 Kimball Drive, Eden Prairie, MN 55347
Telephone Number: 612-669-4389
As of July, 1, 2001, Minnesota’s Freedom of Access to Complementary Care Law (Statute Chapter 146A) requires that you receive and acknowledge that you have received by your signature on the back of this page, the following information prior to your treatment.
Vicky Plante, hereafter, “the Practitioner” has the received following education, training & credentials:
BS – Speech Communication/Communication Studies: St. Catherine University, 2007
2 years, if not completed, Masters in Human Development – Holistic Health and
Wellness Emphasis – St. Mary’s University, 2010 – 2012
Healing Touch Level I: 2008
Reiki Level I: 2010
Reiki Level II: 2010
Advanced Reiki Certification: 2015
Reiki Master Certification: 2015
The Information that follows in quotation marks is required to be on the Client Bill of Rights in bold print by the state statute: “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 INFORMATIONAL 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.”
Complaints: If the client has a complaint or concern about the care or services they have received, the Client may also contact the Office of Unlicensed Complementary and Alternative Health Care Practice located in Minnesota Department of Health:
Mailing Address: P.O. Box 64882, St. Paul, MN 55164-0882
Phone: 651-201-3728 Fax: 651-201-3839
Website: www.health.state.mn.us
Fees, Payment, Insurance: Fees for Energy Treatments are $65.00 per 60 minute session, or a pre-negotiated discount as appropriate. Payment is accepted by cash, check, or credit card. This Practitioner is not on contract with any HMO’s, PPO’s, or any other Insurance Company to provide discounted services. Payment in full for services is expected at the time of service, unless otherwise arranged prior to the appointment. Restorative Healing, LLC requests 24 hours notice for cancellations, and will charge a $15 fee for all returned checks.
Change of Price: Clients have the right to reasonable notice of changes to the prices, services, or policies.
Theory of Treatment: The state requires a “Plain language” summary of the “theoretical approach used to provide services to clients”. The Practitioner uses energetic relaxation methods – Reiki and Healing Touch – to promote the clients’ self healing. The methods involve light touch, if acceptable to the client. Energy healing can also be done hands-off (aura work), if more appropriate to the client. A combination of light touch and aura work is the norm.
Right to Current Information: Clients have the right to complete and current information concerning the Practitioner’s assessment and recommended service that is to be provided, including the expected duration of the service to be provided.
Right to Confidentiality: Client records are confidential and will not be released, unless authorized by the client by writing or as otherwise provided by the law.
Right to Self Access: Clients have the right to access to their own records maintained by the Practitioner’s office, in accordance with state statute sections 144.291 to 144.298.
Personal Interaction: Clients have the right to expect courteous treatment, free from verbal, physical, or sexual abuse.
Other Treatment Available: Other massage therapy services are available to the Client in this same community. This can be located by asking the Practitioner, the provider who referred you to this practitioner, or the following practitioner database: www.amtamassage.org.
Right of Agency: The Client has the right to choose freely among available practitioners and to change practitioners after services have begun, within the limits of health insurance, medical assistance, or other health programs.
Records Transfer: The Client has the right to coordinated transfer of your records when there will be a change in the provider of services.
Right of Refusal: The Client may refuse services or treatment, unless otherwise provided by law.
Right of Nonretribution: The Client has the right to assert any and all of the above-mentioned rights without retaliation from the Practitioner.
I _______________________________ acknowledge by my signature that I have received and understand the Complementary and Alternative Health Care Client Bill of Rights.
Signature ___________________________________ Date ___________________
Practitioner Name: Vicky Plante
Business Name: Restorative Healing, L.L.C.
Business Address: 8337 Kimball Drive, Eden Prairie, MN 55347
Telephone Number: 612-669-4389
As of July, 1, 2001, Minnesota’s Freedom of Access to Complementary Care Law (Statute Chapter 146A) requires that you receive and acknowledge that you have received by your signature on the back of this page, the following information prior to your treatment.
Vicky Plante, hereafter, “the Practitioner” has the received following education, training & credentials:
BS – Speech Communication/Communication Studies: St. Catherine University, 2007
2 years, if not completed, Masters in Human Development – Holistic Health and
Wellness Emphasis – St. Mary’s University, 2010 – 2012
Healing Touch Level I: 2008
Reiki Level I: 2010
Reiki Level II: 2010
Advanced Reiki Certification: 2015
Reiki Master Certification: 2015
The Information that follows in quotation marks is required to be on the Client Bill of Rights in bold print by the state statute: “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 INFORMATIONAL 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.”
Complaints: If the client has a complaint or concern about the care or services they have received, the Client may also contact the Office of Unlicensed Complementary and Alternative Health Care Practice located in Minnesota Department of Health:
Mailing Address: P.O. Box 64882, St. Paul, MN 55164-0882
Phone: 651-201-3728 Fax: 651-201-3839
Website: www.health.state.mn.us
Fees, Payment, Insurance: Fees for Energy Treatments are $65.00 per 60 minute session, or a pre-negotiated discount as appropriate. Payment is accepted by cash, check, or credit card. This Practitioner is not on contract with any HMO’s, PPO’s, or any other Insurance Company to provide discounted services. Payment in full for services is expected at the time of service, unless otherwise arranged prior to the appointment. Restorative Healing, LLC requests 24 hours notice for cancellations, and will charge a $15 fee for all returned checks.
Change of Price: Clients have the right to reasonable notice of changes to the prices, services, or policies.
Theory of Treatment: The state requires a “Plain language” summary of the “theoretical approach used to provide services to clients”. The Practitioner uses energetic relaxation methods – Reiki and Healing Touch – to promote the clients’ self healing. The methods involve light touch, if acceptable to the client. Energy healing can also be done hands-off (aura work), if more appropriate to the client. A combination of light touch and aura work is the norm.
Right to Current Information: Clients have the right to complete and current information concerning the Practitioner’s assessment and recommended service that is to be provided, including the expected duration of the service to be provided.
Right to Confidentiality: Client records are confidential and will not be released, unless authorized by the client by writing or as otherwise provided by the law.
Right to Self Access: Clients have the right to access to their own records maintained by the Practitioner’s office, in accordance with state statute sections 144.291 to 144.298.
Personal Interaction: Clients have the right to expect courteous treatment, free from verbal, physical, or sexual abuse.
Other Treatment Available: Other massage therapy services are available to the Client in this same community. This can be located by asking the Practitioner, the provider who referred you to this practitioner, or the following practitioner database: www.amtamassage.org.
Right of Agency: The Client has the right to choose freely among available practitioners and to change practitioners after services have begun, within the limits of health insurance, medical assistance, or other health programs.
Records Transfer: The Client has the right to coordinated transfer of your records when there will be a change in the provider of services.
Right of Refusal: The Client may refuse services or treatment, unless otherwise provided by law.
Right of Nonretribution: The Client has the right to assert any and all of the above-mentioned rights without retaliation from the Practitioner.
I _______________________________ acknowledge by my signature that I have received and understand the Complementary and Alternative Health Care Client Bill of Rights.
Signature ___________________________________ Date ___________________
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