Client Bill of Rights

Complementary and Alternative Health Care Client Bill of Rights

Please read this client bill of rights, in accordance with Statute 146A, governing alternative health care practices.

  1. Jennifer Krajewski, Energy Kinesiologist
    424 South Washington St., Suite 2A
    Alexandria, VA 22314
    703-338-3595
  2. For a complete resume of degrees, training, experience and qualifications please inquire.
    THE STATE OF VIRGINIA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS. STATEMENT OF CREDENTIALS IS FOR INFORMATION PURPOSES ONLY.
    Under Virginia 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, 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.
  3. I, Jennifer Krajewski, am a sole provider of services, and therefore have no supervisor. Any complaints about services received should be filed directly with me using contact information provided by me.
  4. There is currently no Virginia state office of unlicensed complementary and alternative health care practice to file complaints with. Other traditional authorities will most likely receive complaints. No legal action may be taken against the sole provider of services without the express consent of the practitioner in writing.
  5. Fees for services rendered:
    Energy Kinesiology: $120.00. Appointments generally last 60 minutes.
    Payment shall be made by cash or check only on the day of the appointment.
    Clients must cancel appointments with a minimum of 24-hour notice, or still be responsible for a $60.00 appointment cancellation fee.
    Currently, I know of no specific insurance companies that accept claims for the services offered by me.
    I do not accept Medicare, medical assistance or general assistance medical care. On occasion, I will negotiate to accept partial payment, or at my discretion, waive payment, based on individual client circumstances. I, Jennifer Krajewski, retain the right to discontinue service to anyone at any time.
  6. What follows is a brief summary of the theoretical approach of Energy Kinesiology:
    Energy Kinesiology with a concentration in Applied Physiology uses muscle monitoring, also known as muscle testing – a hands-on biofeedback tool to communicate with the body. Muscle monitoring involves applying light pressure – generally about 2 pounds – usually on an arm or leg, which has been placed in a specific position to isolate the action of a particular muscle. The response of the muscle then offers specific information based on the context in which it is being monitored. The information derived from muscle monitoring/testing assists the practitioner to assess the area(s) of imbalance and identify potential means of energy balancing from a variety of complementary and alternative healing art forms in order to help the client access their innate healing resources.
  7. The client has the right to current and complete information regarding any assessment and recommended service(s) that is to be provided, including the expected duration of the service(s) to be provided.
  8. The client may expect courteous treatment, free from verbal, physical or sexual abuse by me, Jennifer Krajewski.
  9. Client records and transactions that result from services provided by me, Jennifer Krajewski, are confidential, unless release of these records is authorized in writing by the client, or otherwise provided by law.
  10. The client is entitled to have access to records and written information from services rendered by me, Jennifer Krajewski.
  11. The client should be aware that a plethora of health care services are available from other practitioners in the immediate area. These include, but are not limited to: traditional medical treatment, chiropractic, acupuncture and massage.
  12. The client maintains the right to choose freely among available practitioners and change practitioners after services have begun, within the limitations of any health programs that the client may be involved with.
  13. The client has the right to coordinated transfer of practitioners if a change of provider of health insurance services or programs is relevant and necessary.
  14. The client has the right to refuse services or treatment, unless otherwise provided by law.
  15. The above rights of the client may be asserted by the client without retaliation.
  16. Energy Kinesiology is the primary service being delivered. It is a safe, non-invasive method of normalizing the transmission of energy blockages in the body. This is not a method for diagnosing, or curing disease or medical conditions of any kind. I understand that by receiving Energy Kinesiology there may be temporary side-effects such as fatigue, and possible aggravation of the symptoms presented after a treatment.
  17. I, Jennifer Krajewski, do not provide medical care of any kind.

I acknowledge that I have received, read and understand the above Client Bill of Rights.

Signature of client:________________________________________________ Date:___________________________________________________________

Printed name of client:______________________________________________
Address:_________________________________________________________
________________________________________________________________
________________________________________________________________
Phone:__________________________________________________________
Email:___________________________________________________________

Emergency Contact Name and Phone__________________________________