Private Session Agreement

Private Session Agreement

Jeff Forssell, FasterEFT Level III Practitioner Phone: +46 70 35 80 306

About Jeff   I have studied many forms of holistic, alternative healing methods for personal growth and healthy lifestyle. You can see more about my journey to FasterEFT on the homepage. I studied first EFT but moved on to FasterEFT—(Faster Emotionally Focused Transformation), developed by Robert G. Smith. FasterEFT is a comprehensive set of personal transformation skills, which release stress, a leading cause of all problems and symptoms. These highly successful techniques have been used by thousands of people all over the world. Robert G. Smith certified me as a FasterEFT Level III-B Practitioner (with certificate ID: FEFT-B-160) on February 12, 2013.

My mission is to teach personal transformation skills that will enable you to release stress, give you increasing control of your thoughts and emotions, and create a positive affect in the quality of your life.

Disclosure, Responsibility Statement & Client Agreement (The “client” is the signer below)

1. I (the client) understand that Jeff Forssell is not a licensed counsellor, psychologist, therapist, medical doctor, nutritionist or any other medical professional, he has no formal training in these fields and he does not portray himself as such.

2. I (the client) accept complete responsibility for my emotional and/or physical well being before, during and after sessions or classes, and I will instruct others I share these techniques with to take the same responsibility for them.

3. I (the client) agree that it is my responsibility to notify my therapist and/or physician prior to using these skills and agree to their supervision if suggested. I will continue to take all my medications as prescribed and remain under the care of my physician or therapist for any medical, emotional or mental condition for which I am currently being treated or believe I may need treatment.

4. I (the client) will not use these techniques to try to solve a problem where my common sense would tell me it is not appropriate.

5. I (the client) take full responsibility for what I do with these techniques, and will hold harmless Jeff Forssell, or anyone else associated with the techniques, from any claims made by myself, or anyone whom I seek to help. Subject to the other provisions of this agreement, I may use any of the techniques on behalf of others or myself.

6. I (the client) understand that the services provided by Jeff Forssell are limited to education pertaining to my overall well-being. I understand these services may include him physically tapping on my body at various acupressure meridian points. I grant my permission for limited physical contact. I agree to tell him immediately if it causes me any physical discomfort. I understand that these techniques may reveal some problems I had forgotten, but they don’t cause new problems. I understand I can accept or not accept any recommendations and I can terminate our relationship at any time.

7. I (the client) understand that my full identity will NOT be disclosed without my prior consent, if the issues I address during PRIVATE SESSIONS are shared with others in a general way for the purpose of educating them about these techniques.

8. In the event I (the client) am in a group session or class, which is being recorded on video and/or audio media, I agree for Jeff Forssell to use my name, image, likeness and/or voice. I hereby release all claim on confidentiality, interest, royalties, reproductions, distributions and public access of such media.

9. In the event a private session is recorded on written document, video or audio media, I (the client) understand that all r<ecords are confidential and will be for private use by Jeff Forssell or made available to me for an additional fee. Any records of private sessions will not be viewed by anyone else without my prior written consent.

10. I (the client) acknowledge that I have read the above agreement, understand it completely and have, if I so wished, received a copy of the same. I therefore retain Jeff Forssell, as a FasterEFT Practitioner and voluntarily make and grant this Waiver and Assumption of Risk in favor of Jeff Forssell of as consideration for monies paid to the Provider.

Print Name _____________________________Home Phone _________________

Address ________________________________Cell Phone __________________

City, State, Zip _____________________________Birth Date _________________

Email ___________________________________Website: ___________________

SIGNATURE _____________________________Today’s Date__________________

How did you find Jeff? YouTube, FaceBook, FasterEFT Website, Friend or Family, Seminar

Other (please explain) ________________________________________________