Intake & Disclosure Form

Client Agreement and Disclosure Statement

Maren Johanna Miller, Maren J Miller LLC - LoveBubblesHeal

Coach, Consultant, Energy Healer & Intuitive Reiki Inspired Teacher

The following is an outline of the services I provide for my clients and a client agreement to sign before we begin working together. Please ask me any questions you have. 

The Colorado Natural Health Consumer Protection Act requires that all practitioners of “complementary and alternative health care services” give clients a plainly worded written statement that includes items I-V below. Please fill out the information below and send this form when you have read through it all.

(I) Contact Information

My name is Maren J Miller, I am the owner of Maren J Miller, LLC (LoveBubblesHeal). 

  • 5743 Teller Street #325 Arvada, CO 80002         

  • 763-464-1874

  • marenjmillerllc@gmail.com 

  • marenjmiller.com

(II) About Maren Johanna Miller, Maren J Miller LLC 

I offer my services as a complementary and alternative health care practitioner and coach under Colorado’s Natural Health Care Consumer Protection Act. 

I work with clients in a number of areas, including but not limited to: 

  • Life and business coaching

  • Racial identity development

  • mind/body/spirit awareness and connection 

  • Aura readings and healings

  • Psychic mediumship

  • clearing intergenerational patterns

  • overall health through energetic wellbeing and spiritual wellness. 

While working together, you understand that I am not “diagnosing” or “treating” the physical body, which is the domain of the medical field.

  • The services I offer do not replace the services of health care professionals or health care practice.

  • You agree that it is your responsibility to contact healthcare/mental health professionals if you need further support.

  • You understand I may suggest you contact your healthcare/mental health professional if I believe it will benefit your healing.

  • You understand that any information shared during our sessions is not to be considered a recommendation that you stop seeing any of your health care professionals or using prescribed medication. 

(III) Education and Experience

  • Master of Arts in Education, Augsburg College (MN)

  • Bachelor of Arts in Studio Art, St Olaf College (MN)

  • Usui Reiki Master Teacher, Tekla Ayers (CO)

  • Reverend from the Church of Inner Light, Stacia Synnestvedt (CO) - Intuitive Development and Self-Healing Program Graduate 

  • Here is my CV for more

(IV) Regulation and Governance

I offer my services solely as a complementary and alternative health care practitioner. The State of Colorado does not license, certify, or register complementary and alternative health care practitioners. I am not a psychologist, psychotherapist, physician, or other licensed health care professional. Under Colorado’s Natural Health Care Consumer Protection Act, I can offer my services subject to the requirements and restrictions that are fully described therein. I am not a substitute for licensed health care.

(V) Insurance

I understand there is no insurance coverage for these sessions. You are receiving sessions from me at your own risk.

(VI) Fee Schedule

Information about packages, classes, and fees are on my website at marenjmiller.com. Unless other arrangements have been made in advance, payment for your session is due at the time of or prior to service. Invoicing through PayPal, Venmo, CashApp, cash or check accepted. If I must send a check, it will be sent within 24 hours after the session, and no further sessions will be conducted until payment is received by Maren. There are no refunds after the completion of a session.

(VII) Cancelation and Payment Policy

If I need to cancel or reschedule a session, I will email Maren with at least 24-hour notice at marenjmillerllc@gmail.com to avoid being charged for that time. If Maren needs to cancel or reschedule a session, she will provide at least 24 hours notice. A full fee will be expected for a late-start/shortened meeting. 24 hours notice is required when cancelling an appointment. If you cancel with less than 24 hours notice or fail to come to your scheduled session, you agree to pay for the session in full. 

(VIII) Consent for Treatment

I freely consent to receive coaching and support from Maren J Miller (also known as "Maren J Miller, LLC - LoveBubblesHeal”). I am responsible for my own growth, and I determine the effectiveness of the services rendered and the competency of the coach. This is not psychotherapy or counseling. It does not address mental disorders as defined by the American Psychiatric Association. My sessions with Maren are not a substitute for counseling, psychotherapy, mental health care, substance abuse treatment or medical care. If I am struggling from a medical or psychological perspective, I will access professionals in these fields. I am 100% responsible for myself, my choices and behaviors.

(IX) Confidentiality

I understand that all issues related to my sessions will be kept in confidence unless there is reasonable cause to know or suspect self-harm, that a child or elderly person has been subjected to abuse or neglect, or that a child or elderly person is being subjected to circumstances or conditions that would reasonably result in abuse or neglect. This is a professional relationship in which sexual intimacy is never appropriate.

By “signing” and filling the form below, you acknowledge you have received the information described in Paragraph (a) of Subsection 7 of Colorado’s Natural Health Care Consumer Protection Act all of which is provided in this Client Agreement and Disclosure Statement. Per Colorado law, I will keep an original signed copy of this Client Agreement and Disclosure Statement in my records for at least two (2) years.

(X) Final client statement

I acknowledge that I understand the above information. Furthermore, I agree to hold Maren and Maren J Miller, LLC (LoveBubblesHeal) from all liabilities and claims which may arise as a result of my participation in spiritual direction.