WP E-Signature by Approve Me - Sign Documents Using WordPress -

Student Agreement

1. Student and Practitioner Code of Ethics & Standards of Practice

This Code of Ethics is a summary statement of the standards by which Acutonics® students and practitioners agree to be governed and is a declaration of the general principles of acceptable, ethical, professional behavior.

Students and Practitioners Agree To:

Be open and responsive to constructive feedback by colleagues, mentors, and students.
Treat client as part of a community and understand client’s background relative to his or her health issues, coping methods, and future health planning.
Work in collaboration with client to develop a treatment plan understandable to client
Have new clients complete a health questionnaire and sign an informed consent/authorization to treat.
Respect clients’ health care choices.
Address individualized needs of each client.
In the case of a minor brought in by an adult, the minor’s preferences about the adult being present during the session will be respected as much as possible.
Document in detail clients’ case notes.
Comply with all applicable licensure requirements.
Maintain client confidentiality and anonymity at all times, including but not limited to consulting with practitioners, preparing case studies, and presenting to the public.
Protect client identity in written and published case studies and receive written client authorization prior to such use.
Do no harm to the physical, mental and emotional wellbeing of self, clients and associates.
Refer clients to appropriate health and related professionals as needed, and consult colleagues, mentors, or Acutonics for help in referrals as necessary.
Practice only within his or her scope of knowledge and training.
Refrain from engaging in any sexual conduct or relationship with any client for the duration of the practitioner-client relationship and for a minimum of 12 months after the termination of said relationships. Terminate any session in which a client initiates sexual behavior and document any such occurrence.
Never step into the role of psychotherapist without training and license to do so.
Avoid false, deceptive and fraudulent statements about his or her training and experience, the nature of his or her work, and possible outcomes of session work.

Address emotional, spiritual, and psycho-spiritual responses to their experiences with Acutonics in Acutonics® Classes and outside of Classes in an appropriate way, being mindful of and respectful to other students, clients and practitioners.
Demonstrate a commitment to provide the highest Standards of Practice.

Know and comply with all relevant laws and regulations of the state/country in which he or she lives and practices.
Contribute to the ongoing development and body of knowledge in the Acutonics System of Integrative Medicine.
Participate in twenty-four hours of continuing education and training every two years once he or she is designated a Certified Acutonics Practitioner by taking additional courses, attending a bi-annual Practitioner Conference, or doing other agreed upon course work.
Represent Acutonics to the public in a professional manner.
Work with and respect others from diverse backgrounds without any form of discrimination and without imposing his or her own spiritual or political beliefs
Never create an environment where others feel uncomfortable or inferior; create collaborative and safe environments where others feel safe asking questions and expressing doubts.
Communicate clearly to clients’ when/if touching sensitive areas of the body and ask clients if there is an area that should be avoided.
Be aware of and comply with HIPAA Privacy Rules that provide federal protection for individually identifiable health information and give patients an array of rights with respect to their personal information.
Never contact clients via email, texting, social media, mail or phone without their written permission.

Ethical Violations:

All students and practitioners are required to take appropriate steps if they are aware of an Acutonics student, practitioner or Teacher who violates any Acutonics code of ethics, including by speaking openly and compassionately with the student/practitioner/teacher in the spirit of clarifying the situation. If the student/practitioner/teacher is unresponsive and unwilling to recognize any wrongdoing, student or practitioner acknowledges and agrees that he or she will issue a written complaint to the Acutonics Advisory Board in order to maintain the highest professional and ethical standards.

I, , agree to abide by the aforementioned Code of Ethics. I understand that if I violate these tenets, I will be subject to censure and possible revocation of status as an Acutonics student or Certified Acutonics Practitioner.

2. Acutonics® Online: Student Agreement Form

By signing this form, I agree to abide by the Acutonics Institute of Integrative Medicine, LLC student requirements:

To behave in a professional and ethical manner,
To respect the privacy, dignity, and sensitivity of everyone in the class,
To engage in classroom discussion without disrupting the learning process,
To be respectful of the tools used in class recognizing that they are powerful healing tools,
To be respectful of the community that is created within the online class: arriving on time and notifying my instructor, if for any reason I am not able to honor my commitment to be in the video classroom as scheduled.

I understand and accept that this class:
has been adapted for on-line live video streaming and that the teacher may require viewing of pre-recorded modules or review and reading of course material prior to the class. If the course includes hands on practicum it will be demonstrated and explored from the approach of self-care or treating a family member. In the future (when travel restrictions are lifted) I acknowledge that I will be required to participate in in-person practicum events and clinic days.

I understand and agree that the course materials taught in this class are the exclusive intellectual property of the Acutonics Institute of Integrative Medicine, LLC. I agree not to alter, share, teach or distribute in any form whatsoever any materials I receive from my teacher or the Acutonics Institute unless I am authorized to do so in writing from the Acutonics Institute.

I acknowledge that I may state on my website, marketing materials, and social media platforms which specific Acutonics Classes I have taken and how many hours of training I have completed.

I agree not to refer to myself as a Certified Acutonics® Practitioner until I have successfully completed the Acutonics® Certification Program.

I acknowledge that this work is deeply transformational. I agree to be present and mindful of the energetics of the group, within an online learning environment, and to keep confidential any personal information that is shared within the class.

I authorize my Teacher Theresa Lee Morris and/or the Acutonics Institute of Integrative Medicine to record the class and to share the audio portion of the class at their discretion with other students. I also authorize the use of my image and/or audio, visual, or written comments about the class for educational or promotional purposes.

I understand that it is my responsibility to inform the Teacher if there are any existing conditions for which I am currently seeking medical support, or that may limit my participation in the class.

3. Payment and Refund

I acknowledge that once I download these course materials I will no longer be eligible for a refund for this course. If I am unable to attend this class for any reason, I will receive credit to attend at a future date with this instructor.

I agree to be contacted by my instructor(s) or the Acutonics Institute of Integrative, LLC, by telephone, mail, or electronic mail to keep me informed about areas of interest relation to Acutonics.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signed by Theresa Lee
Signed On: January 11, 2022

Timestamp

Audit

April 22, 2021 2:41 pm PDT

Student Agreement Uploaded by Theresa Lee - theresa@kshc.ca IP 209.52.44.123