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Date of Initial Visit____________________

 

Name_______________________________ Date of Birth____________

 

Address____________________________________________________

 

Phone Number(s)_____________________________________________

 

Email Address_______________________________________________

 

Welcome! This document contains important information about my professional services and business policies. It provides a framework for understanding the services I am offering. If you decide to use my services and sign this document, it will represent an agreement between us. 

 

What is EFT Tapping?

EFT means “Emotional Freedom Techniques” and is a powerful self-help method based on research showing that emotional trauma contributes greatly to disease. Clinical trials have shown that EFT tapping is able to rapidly reduce the emotional impact of memories and incidents that trigger emotional distress. Once the distress is reduced or removed, the body can often rebalance itself, and accelerate healing. 

 

What are the limitations of EFT?

EFT can correct energy imbalances in the body and help you to feel better. However, it is not a substitute for the diagnosis and/ or treatment of medical or mental health conditions by a licensed health-care professional. If you have a disorder that has been diagnosed by a licensed medical or mental health care provider, my services should only be used in conjunction with your obtaining that care. I do not diagnose or treat medical or mental health disorders, nor am I trained or licensed to do so. EFT attempts to optimize the body’s overall health and vitality, but it is not to be used instead of appropriate care from a licensed professional. 

 

Confidentiality

Any information discussed or any information either of us comes to know during our working relationship is confidential.  This does not include information that either of us was aware of prior to executing this Agreement, nor does it include information that was gained by a third party, or information that was available to the public through no breach of confidentiality by me.

Confidential information may be shared if and only if waived by both parties in writing. I also reserve the right to break confidentiality, only when I believe the client is a harm to themselves or others. If this is the case, you or your child’s safety is my number one priority and additional support may be requested. 

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Professional Fees/ Late Arrival/ Cancellation Policy

You will be expected to pay required fee in full prior to our meeting unless we agree otherwise. Once an appointment is scheduled, you will be expected to pay unless you provide 24 hours in advance notice of cancellation. If you show up more than 15 minutes late to the scheduled session, you will be asked to reschedule. If you show up late by less than 15 minutes, the scheduled session will resume but will not continue past the scheduled finish time. 

If you miss a session without cancelling, or cancel with less than 24 hours’ notice, you must pay for that session by the time of our next meeting unless we both agree you were unable to attend due to circumstances beyond your control. 

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What to Expect

An average session lasts 60 minutes. A “round” of EFT generally consists of tapping on the side of the hand, followed by the eight “reminder” points while safely tuning into the body, mind, and emotions. I will show you how to tap, and will support you through this process during our time together. I will also teach you how to tap on your own because EFT is most effective when used regularly. Our first session will consist of an introduction to EFT (if required) in addition to tapping. You will be tapping on yourself, unless our session is in person and you are unable to do so. After our first session, I will invite you to tap on the easier issues on your own while saving the more challenging ones for scheduled sessions with me. 

My highest priority is always to keep you safe, meaning that we may not jump directly into any significant trauma or childhood memories until safety and trust has been established.  Some issues can be resolved within a single session, while others may require additional sessions. 

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For the information below, I will be referred at as “Company” and you will be referred to as “Client.”

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Intellectual Property:

Company reserves all ownership rights to any materials including but not limited to documents, images, audio, and video, provided to Client through Client’s participation in the Program covered in this Agreement. Company provides Client with a single-user license authorizing Client to use the materials for their individual purposes only. Client agrees to not share, copy, distribute, disseminate, or sell the materials for either commercial or non-commercial purposes. Client understands that claiming Company’s materials as their own is a violation of intellectual property rights.

 

Non-Disparagement:

Both Parties agree to not take any actions, make any statements, whether oral or in writing, that negatively impact the other party’s business, services, products, or reputation. 

 

Assignment:

This Agreement shall bind both Company and Client and their respective heirs, legal representatives, successors, and assigns.  Client may not assign its rights under this Agreement without express written consent from Company.

 

No Guarantees; Disclaimer: 

NO GUARANTEES: Company makes no guarantees about the results Client may obtain from working with Company.  Client agrees that any statements made by Company regarding potential outcomes are opinions and are not binding on Company. Company may provide testimonials from previous clients, which are not to be relied upon to predict results in Client’s specific situation. The results Client experiences will be dependent on many factors including but not limited to Client’s level of personal responsibility, commitment, and abilities, in addition to those factors that Client and/or Company may not be able to anticipate.

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NOT PROFESSIONAL MEDICAL OR MENTAL HEALTH ADVICE: At no time should any of Company’s services be considered a substitute for professional medical or mental health services, nor should the service be construed as professional therapy. Company’s services are not intended to treat, diagnose, cure, or prevent any disease.  If at any time Client needs medical, and/or psychological treatment, it is Client’s responsibility to seek it out.

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NOT LEGAL OR FINANCIAL ADVICE: At no time should any of Company’s services be considered a substitute for professional legal or financial advice. If at any time Client needs legal or financial services, it is Client’s responsibility to seek it out.

 

EARNINGS DISCLAIMER: Any information provided by Company regarding wealth, abundance, income, earnings, business profits or personal financial status is for informational purposes only. Company may provide real-life examples and/or hypothetical examples of possible outcomes, which are in no way guarantees of what will occur in Client’s specific situation.  Financial outcomes depend on many factors including but not limited to Client’s level of personal responsibility, commitment, and abilities, in addition to those factors that Client and/or Company may not be able to anticipate. Client agrees that Company is not responsible for Client’s success, or lack thereof. Client’s reliance on any information provided by Company is done so at Client’s own risk.

 

Warranties:

Both Company and Client warrant that they have full authority to enter into this Agreement.  Company warrants that its services will be provided by qualified people and in a competent manner in accordance with industry standards.  Client warrants that it has any necessary permission, licenses, rights, and releases to lawfully execute its duties set forth in this Agreement. EXCEPT FOR THE EXPRESS WARRANTIES IN THIS AGREEMENT, NEITHER PARTY MAKES ANY OTHER WARRANTIES EITHER EXPRESS OR IMPLIED.

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Whole Agreement:

This Agreement constitutes the entire agreement between Client and Company. This Agreement supersedes and cancels all prior or contemporaneous oral agreements and written agreements including but not limited to conversations, messages, emails, and negotiations.

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Modification; Waiver: 

The terms of this Agreement cannot be modified, supplemented, or amended unless agreed to in writing by all parties.  The waiver of a term in this Agreement shall not be considered a waiver of any other terms of this Agreement and shall not be considered a continuing waiver.  In order to make the waiver binding, the party making the waiver must execute it in writing.  The modification or waiver of one term of this Agreement does not affect any other term in the Agreement, regardless of its similarity.  

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Severability:

If any term in this Agreement is found to be void or voidable, the remaining terms of the Agreement are unaffected, and deemed to remain in full force and effect, including those terms that are similar. 

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Limited Liability:

THE AMOUNT OF LIABILITY RECOVERABLE FOR ANY CAUSE OF ACTION THAT ARISES UNDER THIS AGREEMENT SHALL NOT EXCEED THE AMOUNT PAID FOR SERVICES OUTLINED IN THIS AGREEMENT, REGARDLESS OF WHETHER THE CAUSE OF ACTION IS BASED IN TORT, CONTRACT OR ANY OTHER THEORY OF LIABILITY.  UNDER NO CIRCUMSTANCES WILL COMPANY BE LIABLE FOR SPECIAL, INCIDENTAL, INDIRECT, OR CONSEQUENTIAL DAMAGES OF ANY KIND, OR FOR ANY LOSS OF USE, BUSINESS INTERRUPTION, COSTS OF PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES, LOST PROFITS, OR LOST DATA, EVEN IF CLIENT HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. 

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Dispute Resolution; Costs and Fees; Applicable Law/Venue:

Both Company and Client agree to make every effort to resolve disputes without the need for third party assistance.  If that cannot be done, Company and Client agree to utilize mediation in order to resolve the dispute.  The mediation will either be held through an online mediation service. Both parties must agree to the mediation service and mediator to assist in resolving the dispute.  Both parties agree that their good faith participation in mediation is a condition precedent to pursuing any other available legal remedies.

 

Parties agree that this Agreement shall be governed by and construed in accordance with the laws of Indiana.  Parties agree that the venue for any court proceedings arising out of this Agreement shall be in Indiana. 

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If Company isthe successful party to the dispute resolution, Company will be entitled to costs and fees incurred in resolving or settling the dispute, in addition to any other relief to which Company may be entitled.

 

 

By signing below, you acknowledge that (1) you are of sound mind; (2) you are not under the influence of drugs, alcohol, or medication such that the forgoing might in any way impair your ability to make an informed, voluntary decision in entering into this agreement; (3) you have given careful and mature thought while reading this agreement; (4) you fully and completely understand each provision of this agreement, both as to the subject matter and legal effect; (6) you have discussed any questions or concerns with me and/or others, and agree to abide by the terms of this agreement during our professional relationship.

 

 

Print name__________________________ Date_________________

 

Signature______________________________