INTERNET EFT COACHING DISCLOSURE STATEMENT AND AGREEMENT

Welcome! This document contains important information about the professional services and business policies of Heather Graham through Internet EFT Coaching. It is rather long because it covers a wide range of possible situations, many of which will not apply to you. Still, it provides a framework for understanding the services you are considering. Please read it carefully and note any questions you might have. We can discuss them during our 20-minute free consult. If you decide you would like to use my services and sign this document, it will represent an agreement between us.

WHAT IS ENERGY HEALING?

The roots of energy healing trace back to Eastern healing practices that work with the acupuncture points, the chakras, and the body’s energy systems. The method involves having you tap with your fingers on specific areas of the skin while recalling a personal response or pattern you would like to change. This is believed to shift the brain’s electrical and chemistry in ways that support that change. There have been many clinical studies supporting the effectiveness of EFT and Energy Psychology, and the amount of scientific research in this area continues to grow. You can find links to specific research studies at www.eftuniverse.com/research if you would like additional information. Despite the growing body of research, EFT is still considered experimental. I have received professional training in all the techniques used in my work and am happy to discuss them with you if you have any questions or concerns.

WHAT ARE THE LIMITATIONS OF CLINICAL EFT COACHING?

I do not diagnose, cure or treat medical or mental health conditions. I am trained and certified in Clinical Emotional Freedom Technique (EFT) and I provide services based on this, through individual coaching. The services I provide aren’t a replacement for any traditional, medical, psychological or psychiatric care that may be needed. If you have been diagnosed with a physical or mental health condition, my services may be appropriate for you in addition to whatever medical or mental health care you may already be receiving, but my services aren’t a substitute for traditional medical or mental health care. By signing this agreement, you are indicating that you understand this distinction. You agree to continue following any recommendations made by your healthcare providers and to seek their professional advice as appropriate before making any health decisions.

The following nine differences between psychotherapy and peak performance coaching are important for you to understand prior to engaging my services:

1. Psychotherapists can provide a diagnosis based on the DSM (the American Psychiatric Association’s Diagnostic and Statistical Manual). A primary focus of psychotherapy is the identification and diagnosis of mental disorders. Coaching does not diagnose.

2. Psychotherapy can provide diagnosis independent of the client’s self-assessment. This function is recognized by third parties such as the courts and insurance carriers, which often call up on psychotherapists to make diagnoses independent of the client’s self-assessment. Coaching, by way of contrast, relies on the client’s self-assessment.

3. Psychotherapy can use its diagnoses to treat clinical disorders. Coaching makes no claims of efficacy in treating clinical disorders.

4. Psychotherapy is often reimbursable by health insurance since diagnosis and treatment is recognized as being part of health care. Coaching is not usually reimbursable since it does not involve diagnosis or treatment.

5. Goals in psychotherapy may be set by the therapist after diagnosis. Goals in coaching are typically self-identified by the client.

6. Psychotherapy goals typically involve treatment of a mental disorder by the therapist. Coaching goals typically focus on quality of life.

7. Psychotherapy typically involves recognized power differentials between client and therapist. This vulnerability of clients gives psychotherapists legal and ethical responsibilities. Coaching is in the nature of a supportive peer-to-peer relationship, with the results evaluated by the client.

8. Psychotherapy may be provided by primary caregivers such as hospitals and may be considered an aspect of primary care. Coaching is not associated with primary care.

9. Coaches are required to refer clients to psychotherapists or psychiatrists if the client’s problem is outside their scope of practice.

MY BACKGROUND AND TRAINING

I have received my Clinical EFT Practitioner certificate through www.eftuniverse.com

SESSIONS

I schedule a package of either three or five appointments of 60 minutes duration per week at a time we agree upon. After we have completed one of these packages, I will consider working with you on single sessions.

PROFESSIONAL RECORDS

I keep personal data and other personal information electronically from our session(s) to better provide you with my coaching services. In addition, these records may be used for billing purposes. The data will not be shared with third parties unless there is a legal obligation. I will maintain your records in a secure location that cannot be accessed by anyone else. I will maintain your records for at least five years after our last contact, after which time I will securely dispose of them.

CONFIDENTIALITY

Except for the special situations described below, please know that your sessions and the content of your sessions are confidential. I take seriously the importance of your feeling safe and secure in order to explore and heal the painful effect of your past experiences.

If I transmit information about you electronically (for example, sending bills or faxing information), it will be done with special safeguards to insure confidentiality. If you elect to communicate with me by email at some point in our work together, please be aware that email is not completely confidential. All emails are retained in the logs of your or my internet service provider. While under normal circumstances no one looks at these logs, they are, in theory, available to be read by the system administrators of the internet service provider. Any email I receive from you, and any responses that I send to you, will be kept as a part of your treatment record. Following are seven exceptions to confidentiality:

1. I will break confidentiality in any situation where legally required and when I deem it necessary for the for the safety of my client or any other member of the public.

2. In certain legal proceedings, particularly those involving child custody or those in which your emotional condition or treatment is an important issue, a judge may order my testimony. Confidentiality is not protected when a judge makes such an order or in certain other legal procedures. Consult with an attorney if you are involved in a legal situation where confidentiality may be at issue.

3. If am consulted by your spouse, partner, or another member of your family, we will in advance establish the limits of confidentiality. It generally limits a practitioner’s effectiveness when required to keep secrets, so my policy in most circumstances is that what you say and what we do can be shared with other family members. If this is what we establish, do not tell me anything you wish kept secret from other intimates I am working with. If confidential information is a concern, it is better for each family member to work with a different practitioner.

4. I may occasionally find it helpful to consult other professionals about a client. During a consultation, I make every effort to avoid revealing the identity of the client. The consultant is also bound to keep the information confidential. If you don’t object, I will not tell you about these consultations unless I feel that it is important to our work together.

5. Should I suddenly become unable to continue to provide my professional services, I have pre-authorized another health care professional to review my case notes and to contact my clients for the purpose of discussing next steps in the energy healing work they were doing with me.

6.  I may authorize clerical staff, who will maintain your confidentiality, to access your records for routine billing, filing of case notes, etc.

While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, please discuss with me any questions or concerns that you may have. I will be happy to explore these issues with you, but formal legal advice may be needed from an attorney because the laws governing confidentiality can be quite complex.

MINORS

If you are under eighteen years of age, please be aware that I will not provide services unless I have written parental or legal guardian’s consent.

PROFESSIONAL FEES

My fee for a 60-minute session varies depending on the service package you have chosen. Please refer to my website Work With Me | Heather Graham (interneteftcoaching.com). If we decide to meet for a longer session or a shorter session, I will bill you prorated on this hourly fee. In addition to scheduled appointments, I also pro-rate the hourly fee for other professional services you may request. Other services might include emergency telephone conversations lasting longer than 10 minutes, listening to lengthy voice mail messages, reading and responding to e-mails other than for routine business, attendance at meetings with other professionals you have authorized, and the preparation of requested records or treatment summaries. If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $150 CDN per hour for preparation and attendance at any legal proceeding.

BILLING AND PAYMENTS

You will be expected to pay for each session at the time it is booked.

Once an appointment is scheduled, if you are late, we will still end on time and not run over into the next person’s session.

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

CONTACTING ME

I am often with a client or otherwise not immediately available to respond to emails, or by telephone. When I am unavailable, I monitor both frequently and will make every effort to return your call or email on the same day you make it, except for weekends and holidays. If it will be difficult to reach you, please inform me of some times when you will be available. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your family physician or, if you are experiencing a medical emergency, call 911 or go to the nearest hospital emergency room.

OTHER ASPECTS OF OUR RELATIONSHIP:

You have the right to ask me questions about anything that happens in our work together. I’m always willing to discuss how and why I’ve decided to do what I’m doing, and to look at alternatives that might work better. You can feel free to ask me to try something that you think will be helpful. You can ask me about my training for working with your concerns and can request that I refer you to someone else if you decide I’m not the right practitioner for you. You are free to terminate our work together at any time.

I never in engage in sexual intimacies with clients or former clients and generally avoid social and business relationships. Beyond the legal and ethical considerations, our work together will be most effective when kept free from possible outside entanglements.

You normally will be the one who decides therapy will end, but there are three exceptions to this. If I determine that I am unable, for any reason, to provide you with the services you are requesting at a high professional standard, I will inform you of this decision and refer you to another therapist who may better meet your needs. Second, if you verbally or physically threaten or harass me, my office, or my family, I reserve the right to terminate you from treatment immediately and unilaterally. Third, I reserve the right to refuse or terminate a session if you or anyone in the session is suspected of being under the influence of a mood-altering substance. You will be responsible and charged for full payment of the normal fee.

If you are involved in legal proceedings based on your having been traumatized, please understand that through our work together, traumatic memories may lose their emotional charge, and this could adversely affect your ability to provide legal testimony that carries the same impact as prior to treatment.

I am away from the office several times each year for vacations or to attend professional meetings. I will make every effort to tell you Well in advance of any anticipated lengthy absences and to discuss other options for continuing to work toward your goals during my absence.

Your signature below indicates that you have read the information in this document, understand it fully, have discussed any questions or matters of concern with me and/or others, and agree to abide by its terms during our professional relationship.

Hereby, I give my consent by filling out and submitting the form below.

“EFT is something I now do often just to calm myself down and not get stressed out.  It works great in traffic, in a store, anywhere that I start to feel discomfort, I do a short, modified EFT session and I always feel better.

Thank you, Heather, for helping me deal with life’s stresses and taking a huge negative out of my life.

I highly recommend Heather and EFT sessions and you will learn how to deal with life difficulties.  Constant stress, physical or mental, is bad for us.” – Susan Struder