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Emotional Freedom Techniques

 Informed Consent Form

I voluntarily request and consent to receive Emotional Freedom Techniques facilitation services from Shannon Burrington.

I understand and acknowledge that no guarantees have been made to me as to the effects or outcome of such services.

I understand that Shannon Burrington is not trained to diagnose or treat any medical or mental health conditions, nor does she have the knowledge to refer me to a particular qualified professional in medicine, psychology, or psychiatry.

Through this understanding, my representative(s) or I agree to fully release and hold harmless Shannon Burrington, from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

If I experience any discomfort during the session, I will immediately communicate that to Shannon Burrington.

Energy modalities are considered experimental for most issues. Reactions may surface during a treatment that neither the coach nor I can anticipate, including bringing up additional memories or emotions.

If either myself or Shannon Burrington deem that the Emotional Freedom Techniques are not significantly effective or result in undesired results, either party has the right to terminate any scheduled services giving as much early notice as possible (see EFT Practice Policies for specifics on visit notice and fees).

The intensity of previously vivid or traumatic memories may diminish. This could adversely impact the ability to provide legal testimony regarding a traumatic incident.

All information in our sessions is to be kept confidential, except in the following cases:

1) If it appears that I may harm myself, or another person. 

2) If I have abused a child or elderly person and this is revealed in a session. 

I have read and understood the information in this document.

Client Signature by clicking here you are signing this form

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