California Client Information Form & Waiver

What EFT is

Emotional Freedom Technique (EFT) is an emotional version of acupuncture except that we tap with our fingers on acupuncture points instead of using needles. The easy-to-learn tapping sequence stimulates the proper flow of energy throughout the meridian system in your body and eliminates energy blockages. While you are gently tapping on specific points located on these meridians, you tune into and focus on an issue. This simple process eliminates energy blockages in your body, which then results in clearing the negative emotions and physical symptoms as well. Acupuncturists know that stimulating and balancing meridians can alleviate pain and other symptoms. EFT, however, works not only with pain, but emotions, phobias, self-esteem and so much more. Sometimes EFT works where nothing else does.

What EFT is not

While EFT has produced remarkable results, it must still be considered to be in the experimental stage and thus the public must take complete responsibility for their personal use of it. Those who want to discuss the use of EFT for a specific emotional problem with a professional in the mental health field may contact Heike for the name and phone number of a local licensed professional or contact www.emofree.com for a practitioner near you.

PLEASE DO NOT ATTEMPT TO PRACTICE EFT WITHOUT SUPERVISION. Properly applied, these procedures will work across the board. However, for some people, it may create distress to explore emotional issues unattended. If you are under a physician's or physiatrist’s care, on serious medications or consider yourself otherwise vulnerable, PLEASE DO NOT ATTEMPT TO DO EFT ON YOUR OWN.

Disclaimer

Release Into Peace and Heike Prevrhal (hereinafter referred to as “Heike”) make no claims, implied or otherwise, regarding the success and/or results from the application of EFT and/or personal coaching/counseling (hereinafter referred to as “services”) provided by Heike. These services are considered experimental and although success rates are in the 80%-90% range, they are as yet undocumented procedures.

Heike is NOT a licensed physician, therapist or psychologist. Heike do not claim to diagnose or treat any illness. EFT is a complement to 'healing arts services licensed by the state', ie, it is a complement to more traditional western medicine provided by doctors, nurse and hospitals. As a complementary or alternative medicine, EFT does not require licensing by the state (for more information, see California Senate Bill 577).

Heike holds a certificate as a Pro-ER / MTT Practitioner. The emotional or physical frailty of some people is such that they should not attempt ANY healing procedure without the presence of a LICENSED THERAPIST. This may be 2% - 3% of the population. If you are in this category, YOU MUST BE ACCOMPANIED BY YOUR MENTAL HEALTH CARE PROVIDER! You take full responsibility for your personal health and safety. Your compliance with all of your current medical treatments, therapies and prescriptions is expected. Heike shall not be liable for any damages or injury arising out of your access to, or inability to access, the services provided. Heike disclaims any and all liability for direct, indirect, incidental, consequential, punitive and special or other damages, lost opportunities, lost profit or any other loss or damages of any kind.

Release

I affirm that the information I have provided above is accurate and true and that I freely enter into this legally binding agreement and acknowledge that I understand and agree with the disclaimer presented above. I, and my heirs, in consideration of my participation in the services provided by Heike and/or Release Into Peace, hereby release Heike, her family and the officers, employees and agents of Release Into Peace, from any and all liability for any loss or damage caused, or alleged to have been caused, directly or indirectly, by the services provided and/or the information or ideas contained, suggested or referenced during the course of the services provided. I understand that my participation in the services provided is strictly voluntary, at my own risk and I freely choose to participate. I understand that Heike and Release Into Peace do not provide medical treatments and/or coverage and I verify that I will be responsible for any and all medical costs I incur, directly or indirectly, as a result of my participation.

I agree that (1) I have not modified this form from its original and (2) Heike nor anyone working with her will have any liability to me for any damage to my emotional or physical health arising in any way whatsoever out of my participation or my use of the techniques.