Please type your name or initials in the space provided I,
understand that deb svanefelt is not a licensed therapist, psychologist or health care practitioner and offers EFT (emotional freedom techniques) and Hacking Reality as a self-help educator only. (Please type your name below)*
I am aware that deb svanefelt does not diagnose or treat illness or disease, and does not prescribe medications. I agree not to discontinue or change any medications I am taking while working with deb svanefelt without consulting my doctor.
I understand that EFT and Hacking Reality are considered experimental procedures and are not a substitute for medical, psychological or psychiatric treatment or medications, and that it is recommended that I work with my primary caregiver for any condition I may have
I understand that EFT and Hacking Reality procedures may bring unresolved and distressing memories and related emotions and physical sensations into my awareness, and it is possible that disturbing material may continue to surface after a session and may require further work to resolve.
I also understand that previously traumatic memories may lose their emotional charge and this could adversely affect my ability to provide convincing legal testimony.
I understand that all information I share with deb svanefelt is confidential and that no information will be released to any third party without my express written consent, with the following exceptions: 1) When there is imminent risk of danger to myself or another person. 2) When there is suspicion that a child, elder or dependent is being sexually or physically abused or is at risk of such abuse. 3) When a valid court order is issued for session records.
Optional: I give deb svanefelt permission to describe the details of my sessions in her blog posts as long as 1. she asks me first, and 2. I have an opportunity to see, vet and give permission for the sharing before it is posted, and 3. my personal anonymity is strictly protected
I understand that deb svanefelt has a 24 hour cancellation policy and I agree to pay for any booked sessions that have not been canceled 24 hours in advance.
I agree to take complete responsibility for my own comfort, health and well-being while working with deb svanefelt. I agree that typing my name below is the electronic equivalent of my actual signature
