Please read the following statement closely and make sure you understand what it means, because I will need you to sign your acknowledgment at the bottom before we have our session.  If you have any questions, or do not understand any part of what follows, please ask me, and I’ll be happy to explain it in better terms. The basic message is that you need to be fully informed about your responsibilities and mine, before we proceed. The first section is about what I am not (counselor, doctor, etc.). The second section says that while I teach tools which I hope you will teach others in your environment, I cannot be responsible for what happens when you do this.

I am providing a professional and confidential service to you in exchange for an agreed upon sum of money, to be paid in accordance with the fee schedule which has been provided to you.  In this capacity, I am only providing the nutrition/healing/teaching service agreed upon.  However, there are limits to what I can provide, which may or may not meet with your expectations of that service, so we need to be clear about what I can do, what I am willing to do, and what I cannot do and am not willing to do.

For instance, I am a nutrition coach, holistic health coach and an ordained minister; I am not a psychotherapist or psychoanalyst, social worker, clinical social worker, psychologist, or registered dietitian and therefore cannot meet any expectation that you might have of me to perform in that capacity.  You will need to rely on the expertise of the appropriate therapeutic providers for any such assistance.  I am also not a medical doctor, or nurse, or nurse practitioner or physician’s assistant, so you will need to rely on the expertise of the appropriate medical providers for any such assistance.

Finally, although I agree to perform to the best of my professional ability, within the stated parameters of the agreed-upon service provided, I do not agree to any service not discussed or agreed upon, and am not responsible for any adverse result should you use the information you have learned/received here for purposes other than those services or within those parameters agreed upon.

For instance, if you learn a healing technique here, and then, without proper training and education, hold yourself out to another person to be an expert, I am not legally responsible for any consequences – either negative or positive – flowing from your decision to act in such a capacity.  Although I have an insurance liability policy, it will not answer for any legal liability or damages to any person or property, flowing from any service not covered under this agreement, or for any legal liability or damages to any person or property, flowing from your conduct or behavior in any capacity outside the scope of this agreement.

In particular, you may learn Meridian Tapping Therapy (MTT) or Emotional Freedom Technique as a technique which may be used for a variety of issues. While MTT has produced remarkable clinical results and been used by thousands of therapists, nurses, social workers, psychologists, and doctors, it must still be considered to be in the experimental stage and thus you are advised to take complete responsibility for your use of it. As stated above, I am not a licensed health professional.

I offer meridian tapping and other energy modalities, nutritional coaching and shamanic reading as a coach with a recent (2011) Masters in Holistic Health and Nutrition and as an ordained minister with a Masters in Divinity.

By checking the box below, you agree to the terms of the service(s) provided, and consent to abide by the conditions of confidentiality and professionalism set out above.  But more importantly, your signature check acknowledges that you clearly understand what my role is, and what it is not, and what service I am providing, with your consent.  This should help you to frame your expectations of me, and you, and allow us to relax into the session.

Please ask me if you have any questions before signing this agreement.  When I have received this form from you, we can begin. A scanned copy is acceptable. You may also send me an email saying that you have read this disclaimer and agree to it.

___________ Signature  – I have read this document and want to have a session.

___________ Date




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