DISCLOSURE STATEMENT
AS REQUIRED UNDER SB-215 FOR
COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS
IN COLORADO

 Practitioner Name:                 Susan (Suzy) Riding

Practitioner Address:              880 West Moorhead Circle Unit 3L Boulder, CO 80305

Practitioner Phone No.:           970-690-7986

As a Complementary and Alternative Health Care Practitioner, I am not licensed, certified or registered by the State of Colorado as a health care professional. I am not a licensed medical physician and do not diagnose, treat or prescribe remedies for the treatment of disease. The services I perform, whether in person, by online platform, by mail or by phone, are at all times, restricted to complementary and alternative healthcare services intended for the maintenance of the best possible state of nutritional health. I am prohibited from performing surgery or any invasive procedure, administer or prescribe x-ray radiation, prescribe prescription drugs, use general or spinal anesthetics, administer ionizing radioactive substances, use a laser device that punctures and skin, perform enemas/colonics unless board certified, practice midwifery, practice psychotherapy, perform spinal manipulation, practice optometry, directly administer medical protocols to a pregnant woman or a person who has cancer, practice dentistry, set fractures, practice massage therapy, provide a conventional medical disease diagnosis or recommend the discontinuation of a course of care recommended by a health care professional. I am also prohibited from treating children less than two years of age. To treat a child who is between 2-8 years of age, I must have a written, signed consent of the child’s parent or legal guardian.

______________________                            _________________________________
Name of Child (Age 2-8)                                    Signature of Parent/Legal Guardian

The services I provide are as follows: Reiki, Kriya Yoga Meditation Instruction and Training

My professional degrees, training, experience, credentials and qualifications are as follows:

Level II Reiki Certification (Green Light Reiki)

Four and half years of Kriya Yoga Meditation training through PBP Ministries.

As an empath and intuitive I have been working with energy my entire life. 

I do carry liability insurance applicable to any injury caused by an act or omission in providing complementary and alternative health care services.

A copy of this disclosure statement will be kept on file for at least two years after the last date of service.

As my client, you should discuss any recommendations I provide with your Primary Care Physician, Obstetrician, Gynecologist, Oncologist, Cardiologist, Pediatrician or Pediatric Health Care provider, or other Board Certified Physician.

_____________________                          _____________________________
   Name of Client (Print)                                            Signature of Client

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Address of Client (Print)                                     City, State, Zip Code (Print)

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Phone Number of Client                                       E-Mail Address of Client

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Date of Birth                                                          Date of First Visit