DISCLOSURE STATEMENT AS REQUIRED UNDER SB-215 FOR
COMPLEMENTARY AND ALTERNATIVE HEALTHCARE PRACTITIONERS IN COLORADO
- Matthew Cavanna
- 9090 Judson Street Westminster, CO 80031
As a Complementary and Alternative Healthcare Practitioner, I am not licensed, certified or registered by the state of Colorado as a healthcare professional. I am not a licensed mental health professional, psychotherapist or physician, and I do not diagnose, treat or prescribe remedies for the treatment of disease. The services I perform, whether in person or by phone, are at all times restricted to complementary and alternative health care services intended for the maintenance of the best possible state of general well-being.
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 the 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 healthcare professional.
Further, you understand the services I offer: coaching, spiritual counseling, movement instruction, light touch therapy and mindfulness/meditation and energy work, are not intended to be a substitute for medical or psychological treatment. They do not replace the services of health care professionals. You agree and understand it is your responsibility to consult with your health care provider for any specific health care or mental health care problems.
By signing this document you understand I am offering my services solely as a complementary and alternative practitioner and our relationship is not to be construed as medical treatment, psychotherapy, psychological counseling, or any type of therapy, nor is it a substitute for these services.
I am prohibited from treating children less than two years of age. In order to treat a child who is between 2-18 years of age, I must have a written, signed consent of the child’s parent or legal guardian.
The services I, Matthew Cavanna/Living Bridges, provide are as follows: Coaching, Spiritual Counseling, Instruction in Movement and Contact Improvisation, Limbic Imprint Recoding, Reiki Treatment/Light Touch Therapy, Meditation Instruction, Mindfulness, Family Constellations and various Somatic Practices such as yoga, mind-body experiencing, Feldenkrais method, authentic movement, energy work etc.
My professional degrees, training, experience, credentials and qualifications are as follows:
Hakomi: Completed Comprehensive Training, Years One & Two, Attending to Attachment (8 day training on Applied Attachment Theory), From Trauma to Dharma (8-week trauma training). All trainings taken and then later assisted.
The Re-Creation of the Self Model of Human Systems (R-CS Model) with John Eisman. Training taken and then later assisted.
Birth Into Being Facilitator In Training: Certification by Elena Tonetti-Vladmirova in Limbic Imprint Recoding
Family Constellations: Completed a 10-day training in Family Constellations with ConstellationWorks in Mill Valley California in 2012. http://www.constellationworks.com/
Reiki & Energy Work and Touch Therapy: Two years’ study at Foundation for Spiritual Development. Reiki levels 1 & 2 certification. Craniosacral Therapy Training. I also have over 250 hours of training in Massage Therapy from Alive & Well School in California which included Swedish, Deep Tissue, Polarity Therapy, Trigger Points and Belly Massage (though I do not provide massage therapy in the State of Colorado)
Meditation: Trained at the Foundation for Spiritual Development to teach Vajrayana meditation; Multiple silent retreats and mindfulness meditation instruction
Contact Improvisation/Dance/Movement: Over 20 years training and teaching Contact Improvisation. Studied with Keith Hennesey, KJ Holmes, Paul Langland, Jess Curtis, Martin Keough, Simone Forti, Bonnie Bainbridge Cohen, Gabrielle Roth, Frey Faust and others. Forms studied include Contact Improvisation, ballet, modern dance, Axis Syllabus, Ido Portal Method, Body-Mind Centering, I facilitated Ecstatic Dance for 8 years.
Yoga: Completed Certification in 200 hour Anusara Yoga Teacher Training
Neurolinguistic Programming: 50 hour online training
Emotional Freedom Technique: Levels One, Two and Three with Sonya Sophia
BFA in Acting From NYU
(Currently completing M.A. in Marriage and Family Therapy, Licensed Professional Clinical Counseling (LPCC) Track at Touro University)
Spiritual Leader of Medicine Path Affiliate Branch Church: Blessing given by George “Grayeagle” Bertlestein January 2017
Licensed Minister: Universalist Life Church
Matthew Cavanna/Living Bridges is a Member of Wellness Elements Collective, a collaborative care and referral network for Complementary and Alternative Health Practitioners, under the leadership of Karla Birkholz M.D.
I carry liability insurance applicable to any injury caused by an act or omission in providing coaching and movement/fitness instruction and related contact.
By signing the client agrees that he/she understands the limits of services and scope of practice for Matthew Cavanna/living Bridges. A copy of this disclosure statement will be kept on file for at least two years after the last date of service.
Practitioner Signature Date
Client Signature Date