Signatures of understanding and Permissions

For ALL Apprentices, please read and electronically sign for each of the documents below.  You may download and keep a copy of any of these documents for your records.  

Institute of shamanic Healing ​Policies and Procedures

These policies and procedures of the Institute include information on:

Program Content and Responsibility
Program and Apprentice Responsibility
               for Shamanic Healing Interventions
Program Certification Policies
​Program Payment Policies
Vision Quest Policy

Please download a copy for your records.  

Signature for
​Policies and Procedures

    My signature below indicates that I have read and understood the policies and procedures of the Institute of Shamanic Healing.  

NOTICE OF PRIVACY PRACTICES FOR THE INSTITUTE OF SHAMANIC HEALING, LLC

The privacy of your health information,  having to do with your healing sessions is important to the Institute of Shamanic Healing and to the Apprenticeship Leader.  The Institute will maintain the privacy of your information and will not disclose your information to others unless you request such disclosure, or unless the law authorizes or requires the Institute to do so.  

A federal law commonly known as HIPAA (Health Insurance Portability and Accountability Act) requires that the Institute take additional steps to keep you informed about how the Institute may use information that is gathered in order to provide services to you.  As a part of this process, the Institute is required to provide you with the Notice of Privacy Practices and to request that you sign below as acknowledgement that you've received a copy of the Notice.  
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Please download a copy for your records.
    My signature below indicates that I have read and received a copy of the Notice of Privacy for the Institute of Shamanic Healing.  

Professional Disclosure Statement (PDS) - Selena Whittle

 The Professional or Personal Disclosure Statement is required by law for counselors and psychotherapists. 
If your Apprenticeship Leader is licensed as a counselor or psychotherapist, a signed Professional Disclosure Statement is required in order for you to have healing sessions.  ​ Please download a copy. 
    My signature below indicates that I have read and understand the Professional Disclosure Statement of my Apprenticeship Leader.  

Financial Agreement to Pay for Services Rendered

    Your signature below indicates that you have agreed to pay for all services rendered during the course of the program.  Please download a copy for your records.  ​

Permission to photograph