Stressed Self to Best Self™ Success Mindset CoachingCONFIDENTIAL CLIENT INTAKE & INFORMED CONSENT FORMName:Address:Home Phone:Work Phone:Cell Phone:Email:Website:Date of Birth: MM slash DD slash YYYY Occupation & Workplace:Have you worked with a coach before? If so, what type of coaching and when?Have you received any previous Emotional Freedom Techniques (EFT, Tapping, Meridian Tapping) sessions? If so, when?Please check √ what areas you would like to focus on with Success Mindset Coaching, including EFT. If there is an area that does not apply, simply leave it blank. We’ll discuss further details during your first coaching session: Health Career/Job/School Financial Relationships Personal SpiritualEFT INFORMED CONSENT | Please view the “How To Do EFT” information page on Dr. Jennifer Harrison’s website prior to your first EFT session. This will only take about 25 minutes. Please write down the date that you finished viewing the below page: MM slash DD slash YYYY Here is the link: https://drjenniferharrison.com/eft-tapping/Although to date there are over 100 published studies showing the effectiveness of Emotional Freedom Techniques, also known as EFT, EFT Tapping or just Tapping, for addressing a wide variety of issues, EFT Tapping is still considered to be in the experimental stages. The information provided regarding EFT Tapping is meant to be educational in nature only and is not to be used to replace advice or treatment from any health care professional. If you are currently receiving treatment for a mental, emotional, spiritual and/or physical health condition, you should consult your licensed health care practitioner before using this technique. Due to the experimental nature of EFT Tapping and because it is a relatively new healing approach and the extent of its effectiveness, as well as its risks and benefits are not fully known, you agree to assume and accept full responsibility for any and all risks associated with receiving EFT Tapping sessions, viewing Dr. Jennifer Harrison’s website, listening to any recordings or watching any videos, and acting on any information contained on the website and/or in any such recordings or videos. Please note, if you choose to voluntarily use EFT Tapping, previously vivid or traumatic memories may fade, which could adversely impact your ability to provide detailed legal testimony regarding a traumatic incident. Although people report having positive experiences with EFT Tapping, please be advised it’s possible to experience emotional distress or physical discomfort which could be perceived as negative side effects. If you inadvertently experience any emotional distress or physical discomfort while Tapping, especially if you are pregnant, you are advised to stop and to seek professional care, if appropriate. I, (enter name below) First Last ...have read the above EFT informed consent information, viewed the “How To Do EFT” page on Dr. Jennifer Harrison’s website as listed above, had the opportunity to ask Dr. Jennifer Harrison, EFT Practitioner, any questions I had and thereby consent to proceeding with EFT as part of Success Mindset Coaching. I agree to proceed with EFT as part of Success Mindset Coaching.Δ
