Ca SB577....and Chi Nei Tsang
Jak Noble is a California health care service provider of complementary and alternative health care practices and makes the following disclosures pursuant to Sections 2053-5 and 2053.6 of the California Business and Professions Code as enacted into law by SB577 and approved by the Governor on September 23 2002.
I am not a licensed physician and do not diagnose illness, disease, or mental disorders, nor do I prescribe treatment or pharmaceuticals.
The services provided here are alternative or complementary to healing arts services licensed by the State of California.
Chi Nei Tsang and the other services provided by Jak Noble are not licensed by the State of California.
Chi Nei Tsang is an Eastern therapy akin to the Western modality called Visceral Manipulation. Techniques to improve breathing and fundamental self-help skills to improve the function of the internal organs are taught. I provide guidance in personalizing diet and other health-related lifestyle matters, and specific and relevant visualization and meditation practices to further enhance the effect of manual treatments.
Jak Noble is trained in Chi-Kung, and works mainly on the abdomen with deep, soft and gentle touches, to train internal organs to work more efficiently. Unprocessed emotional charges are addressed in this manner, as well as all of the body systems: digestive, respiratory, cardiovascular, lymphatic, nervous, endocrine, urinary, reproductive, muscular-skeletal, and the energy pathways of the meridian system. This training holds a belief that we are all responsible for our own health and that healing comes from within.
Jak Noble has a minimum of 500 hours of training in Chi Nei Tsang and related techniques. Copies of certificates are posted in the treatment room for your review. He welcomes questions about his background, education and experience in Chi Nei Tsang.
Please sign below to acknowledge the following, as required by law:
• I have read and understood the information provided by the disclosure form.
• I have been given a copy of this disclosure form for my records.
• I understand that Jak Noble is required to maintain my signed copy of this disclosure form for a period of three years from this date.
I understand that there is a 48 hour cancellation policy, and agree to be financially responsible for appointments that I am unable to keep. This policy goes both ways, with Jak Noble offering your next treatment free of charge if he is unable to keep a scheduled appointment or arrange for another qualified practitioner to stand in for the session.
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Signature Date
Print your name Turn over to input contact information---
Address ______________________________________________
______________________________________________
______________________________________________
Phone ______________________________________________
Mobile ______________________________________________
Email ______________________________________________
Birthdate ______________________________________________
Who to contact in case of emergency:
Name ______________________________________________
Phone ______________________________________________
Name ______________________________________________
Phone ______________________________________________
Who may I thank for referring you?
______________________________________________
_____________________________________________
I am not a licensed physician and do not diagnose illness, disease, or mental disorders, nor do I prescribe treatment or pharmaceuticals.
The services provided here are alternative or complementary to healing arts services licensed by the State of California.
Chi Nei Tsang and the other services provided by Jak Noble are not licensed by the State of California.
Chi Nei Tsang is an Eastern therapy akin to the Western modality called Visceral Manipulation. Techniques to improve breathing and fundamental self-help skills to improve the function of the internal organs are taught. I provide guidance in personalizing diet and other health-related lifestyle matters, and specific and relevant visualization and meditation practices to further enhance the effect of manual treatments.
Jak Noble is trained in Chi-Kung, and works mainly on the abdomen with deep, soft and gentle touches, to train internal organs to work more efficiently. Unprocessed emotional charges are addressed in this manner, as well as all of the body systems: digestive, respiratory, cardiovascular, lymphatic, nervous, endocrine, urinary, reproductive, muscular-skeletal, and the energy pathways of the meridian system. This training holds a belief that we are all responsible for our own health and that healing comes from within.
Jak Noble has a minimum of 500 hours of training in Chi Nei Tsang and related techniques. Copies of certificates are posted in the treatment room for your review. He welcomes questions about his background, education and experience in Chi Nei Tsang.
Please sign below to acknowledge the following, as required by law:
• I have read and understood the information provided by the disclosure form.
• I have been given a copy of this disclosure form for my records.
• I understand that Jak Noble is required to maintain my signed copy of this disclosure form for a period of three years from this date.
I understand that there is a 48 hour cancellation policy, and agree to be financially responsible for appointments that I am unable to keep. This policy goes both ways, with Jak Noble offering your next treatment free of charge if he is unable to keep a scheduled appointment or arrange for another qualified practitioner to stand in for the session.
-------------------------------------------------------------------- ------------------
Signature Date
Print your name Turn over to input contact information---
Address ______________________________________________
______________________________________________
______________________________________________
Phone ______________________________________________
Mobile ______________________________________________
Email ______________________________________________
Birthdate ______________________________________________
Who to contact in case of emergency:
Name ______________________________________________
Phone ______________________________________________
Name ______________________________________________
Phone ______________________________________________
Who may I thank for referring you?
______________________________________________
_____________________________________________