Complementary & Alternative Health Care Client Bill of Rights
Practitioner Name: Erin Howk Bennett, BCTMB
Business Name: TSRM with Erin Howk BCTMB, LLC
DBA: Therapeutic & Stress Reduction Massage
Business Address: 72 Downtown Plaza, Fairmont, Minnesota 56031
Telephone number: 507-399-8253 www.tsrmassage.com
As of July 1, 2001, Minnesota’s Freedom of Access to Complementary Care Law (Statute Chapter 146A) requires that you receive and acknowledge that you have received by your signature on the back of this page, the following information prior to your treatment.
Erin Howk Bennett, BCTMB, hereafter, “the Practitioner” has the received following education, training & credentials:
710 Hours Contemporary Western Massage from the Chicago School of Massage Therapy. Studies included Hydrotherapy, Deep Tissue Massage, Swedish Massage, Chair Massage, Kinesiology, and Anatomy. Continuing education in Chair Massage, Pregnancy Massage, Basic Cupping, and further study in Deep Tissue massage. Studies in Ashiatsu Oriental Bar Therapy (a.k.a. DeepFeet Bar Therapy™) and Ashi-Thai™ massage. Board Certified in Therapeutic Massage and Bodywork. Bodywork with hospice and cancer. Studies in massage research, ethics, and self care.
The Information that follows in quotation marks is required to be on the Client Bill of Rights in bold print by the state statute: “THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATION PURPOSES ONLY.
Under Minnesota 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, chiropractor, or acupuncture practitioner, 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."
Complaints: If the Client has a complaint or concern about the care or services they have received, the Client may also contact the Office of Unlicensed Complementary and Alternative Health Care Practice located in Minnesota Department of Health:
Mailing address: P.O. Box 64882, St. Paul, MN 55164-0882
Phone: 651-201-3728 Fax: 651-201-3839
Fees, Payment, Insurance: The Fees are as follows: $50 for 30 min, $75 for 60 min Contemporary Western massage, $75 for 60 minutes FasciFeet massage, $110 for 90 minutes. All taxes are included. The practitioner accepts cash, local check, Visa, Mastercard, Discover, and American Express. Payment is due at the time of the session. The practitioner is not under contract with any insurance carrier, nor does she file claims for Auto Claims, Personal Injury, Commercial Insurance, Medicare or Medical Assistance. 24 hours notice is required for cancellation of appointments. Missed appointments without prior notification may be subject to a fee of 100% of scheduled massage. Appointments can be made online at the designated web address 24/7. Gift certificates are good for one year from purchase date and are non-refundable.
Change of Price: While changes in session fees can occur, reasonable notice of those changes is provided by session fees being posted in the Practitioner’s office, or by the client asking when scheduling the appointment.
Theory of Treatment: The state requires a “Plain language” summary of the “theoretical approach used to provide service to clients”. The Practitioner’s Theory of Treatment is Deep Tissue Massage, Swedish-Style Relaxation Massage, and AOBT techniques to help her clients reduce pain, improve circulation of blood and lymph and improve range of motion and mobility and reduce stress.
Right to Current Information: Clients have the right to complete and current information concerning the practitioner's assessment and recommended service that is to be provided, including the expected duration of the service to be provided.
Right to Confidentiality: Client records are confidential and will not be released unless authorized by
the client in writing or as otherwise provided for by law.
Right to Self Access: Clients have the right to access to their own records maintained by the Practitioner’s office, in accordance with state statute sections 144.291 to 144.298;
Personal Interaction: Clients have the right to expect courteous treatment, free from verbal, physical, or sexual abuse. Clients have the right to end a session at any time without payment if any misconduct on part of the practitioner occurs. Practitioners have the right to expect the same treatment from clients in return. Practitioner reserves the right to cancel a session with the full amount due at any time if any misconduct occurs, including but not limited to sexual innuendo, proposition, or abuse.
Other Treatment Available: Other massage therapy services are available to the Client in this same
community. These can be located by asking the Practitioner, the provider who referred you to this practitioner or the following practitioner database: www.amtamassage.org
Right of Agency: The Client has the right to choose freely among available practitioners and to change practitioners after services have begun, within the limits of health insurance, medical assistance, or other health programs
Records Transfer: The Client has the right to coordinated transfer of your records when there will be a change in the provider of services
Right of Refusal: The Client may refuse services or treatment unless otherwise provided by law.
Right of Nonretribution: The Client has the right to assert any and all of above-mentioned rights without retaliation from the Practitioner.