Informed Consent and Release of Liability Emotional Freedom Technique (EFT) Treatments

 

EFT Practitioner: Timea Katalin Marton

Your Full Name (“Client”): to be confirmed

Date(s) of initial treatment (“Client”):(to include all future sessions implicitly): to be confirmed

Address: to be confirmed

Phone (UK mobile number): to be confirmed

Email address: to be confirmed

Emergency Contact - Name/Relationship to me: to be confirmed

Emergency Contact - Phone Number: to be confirmed

NOTE: The term "Think Transformation Ltd" in this Agreement include thinktransformation.org and implicitly include Timea Katalin Marton, Director of Think Transformation Ltd, who is an EFT International (EFTi) accredited certified EFT Practitioner, and the term “Katalin” as herself, the “practitioner”. Think Transformation is a trading name of Think Transformation Ltd, registered address at 1B Blackfriars House Parsonage, Manchester, Greater Manchester, M3 2JA, Company Number 13262406, a Private Limited Company Registered in England and Wales. All reference to “EFT sessions” or “session” below may also include any other affiliated techniques and methods that Timea Katalin Marton may choose to draw on in the session in addition to Emotional Freedom Techniques (EFT), such as Neuro-Linguistic Programming (NLP), mBraining or Multiple Brain Integration Techniques (mBIT), Life Coaching and Executive Coaching tools, Transactional Analysis, DISC psychometric profiling, adult ADHD and neurodiversity related coaching tools and concepts, in order to facilitate the most appropriate session tailored to the client.

EFT sessions can sometimes bring suppressed feelings to the surface and whilst EFT is a powerful method to help release these gently, sometimes other suppressed emotions and feelings can arise in the time following the session (hours/days). If this happens these may naturally subside or it may be important to schedule a short phone / zoom session (subject to mutual availability) to help with any strong feelings before you are able to come for a follow-up session. Alternatively, you can work with other EFT practitioners or, of course, other suitable modalities should the above arise.

If you have been formally diagnosed with any mental illness, please ensure you have taken advice from your health care professional about the suitability of having an EFT session. EFT does not claim to cure, treat or diagnose any physical condition. If you have a specific physical symptom or condition, it is your responsibility to see a qualified Doctor / MD as a priority.

Confidentiality

All personal details and any information arising in the sessions are 100% confidential with the exception of the following situation(s): the practitioner (Katalin) is legally obliged to inform relevant parties, potentially including, but not limited to your doctor, or family members affected if you are considering causing harm to yourself (e.g. suicide) or others.

The practitioner (Katalin) recognises that anything the client shares with them is regarded as confidential, whether it is business or personal information. The practitioner undertakes not to, at any time, either directly or indirectly, use or disclose any information that the client shares with them during their sessions unless legally required to do so, and except where the practitioner has concerns for individual safety (including the onset of medical emergencies), the safety of others, negative legal impact or by prior agreement with the client.

The practitioner reserves the right to inform your emergency contact in the very rare situation where you suffer an acute physical or severe mental issue whilst in a session where she is concerned for your welfare.

Please note that your practitioner reserves the right to be able to ask questions to her trainers, mentors or supervisors which may involve sharing anonymised content about your session(s). Your name will not be shared, however, and only the minimum will be shared in order to be able to get their support in the appropriate context.

Pregnancy (or suspected pregnancy)

It is generally known that risk of miscarriage is higher in the first 3 months of pregnancy. Apart from the rarely used above-inside-ankle acupuncture points (which Katalin never uses on women anyway), Katalin is unaware of any contraindication in the use of EFT in pregnancy. However, if miscarriage occurs at any point you may attribute it to the session. By proceeding with the session you are agreeing not to hold the practitioner or the session (including future sessions) liable for this and take full responsibility for your participation in the session(s). Katalin personally believes that as the session work is intended to ultimately release stress in the system and increase peace, it may therefore be considered to be beneficial to a healthy pregnancy.

Declaration of Understanding and Acceptance of an EFT Session

I, as the client, understand that the ideas, procedures and suggestions provided by Timea Katalin Marton and Think Transformation Ltd are not intended as a substitute for consultation with my professional health care provider. I further understand that the information provided by Timea Katalin Marton and Think Transformation Ltd is not to be used to diagnose/treat any particular disease on any particular person, including myself, friends or family.

Furthermore, I understand that there is a direct link between mental/emotional states and the physical body and that it is possible that doing EFT could result in physical symptoms coming to the surface.

I declare that Timea Katalin Marton and Think Transformation Ltd is not liable or responsible for any loss or damage to me, as the client, in any matter whatsoever, and irrevocably release Timea Katalin Marton and Think Transformation Ltd from any and all claims of loss, injury or miscarriage (as relevant) sustained by me, however arising, present and future, known, and unknown at this time. I hereby forever release, discharge, acquit and forgive Timea Katalin Marton and Think Transformation Ltd from any and all claims, actions, suits, demands, agreements, and each of them, if more than one, liabilities, judgments, and proceedings both at law and in equity arising from the beginning of time and in the future. If I institute any legal proceedings against EFT subsequent to this release, I agree that these legal proceedings or complaints will be dismissed at my cost with prejudice against me. This release is binding on me, my successors, assigns, agents, and representatives. I also understand that this contract is subject only to England and Wales jurisdiction, therefore any claims must be made through England and Wales courts.

As the client, I confirm that I fully read, understood and accept all the above and take full responsibility for myself mentally, emotionally and physically. I agree to receiving EFT sessions understanding and accepting the above fully. If this treatment is for a child and I am parent / guardian I likewise agree to EFT sessions on his/her behalf.

N.B. If the session is for a child under 16 years the signature below needs to be that of the parent / guardian.

EFT Client Signature:

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Date:

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EFT Practitioner Signature

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Date:

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