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INFORMED CONSENT REGARDING ARCHETYPE ENERGY TRANSFORMATION ©

Dr. Clifford Schilke has advised me that his unique approach to anxiety and psychological stress, ARCHETYPE ENERGY TRANSFORMATION ©, does not rest upon a scientifically proven body of information or data demonstrating its application, value or worth. Rather it is his own unique synthesis of a variety of techniques drawn from 10 or more other energy methods, for which he has received intensive training over the past 25 years. In addition, at the core of his approach, is a completely original idea/procedure, which he developed in the course of using this method successfully with a number of patients. In summary, there is literally no one else who uses Dr. Schilke‚Äôs approach.

Since insurance companies assume that a billable procedure with a standard procedure code represents a method or treatment which is supported by scientific data or widespread and accepted use within the psychotherapeutic community, Dr. Schilke believes that to bill any insurance company for his method would constitute insurance fraud. He will not therefore provide me with any bill for his services which I could use for reimbursement from my insurance company. I must therefore consider the fee that I will pay him to be an out-of-pocket expense, for which I will never be compensated by any insurance company. When he first contacts me, Dr. Schilke will disclose his fee prior to my making an initial appointment with him. At that time, he will also answer all my questions regarding his method. Finally, Dr. Schilke will make no effort to convince my insurance company of the value of his services since his personal experience and testimony as to its value do not constitute the kind of information they would require.