Consent for EFT/Energy Psychology coaching


Acorn Healing Arts, LLC

Mori Jo Montagne, BSN, MN, EFT-ADV

Emotional Freedom Technique Consent Form

 I, _______________________, understand that the Emotional Freedom Technique (EFT) and Energy Psychology Coaching sessions performed by Mori Montagne, BSN, MN, EFT-ADV, are intended to facilitate the uninterrupted flow of energy along the body’s primary energy meridians by releasing any energy blockages created along these pathways by negative emotional (energetic) impact, allowing the body to function more efficiently and healthfully. I understand that while some benefits are immediately perceivable, other “conditions” may take more persistence and patience to heal or improve and that no guarantees of “cure” are given.

 I understand that EFT and Energy Psychology are not a substitute for medical treatment or medications, and that Mori Montagne as the practitioner of these modalities does not diagnose illness or disease, nor prescribe medications by this method of treatment. I also understand that Mori Montagne is not a licensed counselor or psychotherapist and that any other medical training, licensure, or certification she may hold did not include training in this technique and does not apply to this treatment modality. If I feel I have a serious psychological disorder or am in any other way in need of immediate medical attention, I agree to obtain that care through a licensed medical professional before pursuing EFT or Energy Psychology further.

 I understand that participation in an EFT and Energy Psychology sessions is always voluntary and that I may choose to end my participation and assume responsibility for my own emotional wellbeing and limits. I understand that EFT and some aspects of Energy Psychology entail light tapping and touching of energy points on the body. The EFT practitioner will inform me where to tap and/or touch acupressure points through the session.

 I understand that information exchanged during any EFT or Energy Psychology session is educational in nature and is to be used at my own discretion. I also understand that all information from these sessions is confidential and will not be released without my prior written consent, except as required by law.

 I understand and agree that by providing this informed consent I am assuming full responsibility for my EFT and/or Emotional Psychology session(s). I agree to hold harmless the Mori Montagne as the EFT and Emotional Psychology practitioner as well as the facility/location where the session is provided when the session is provided in person.

 Since time has been specially reserved for me, I understand that a 24-hour cancellation notice is expected and appreciated.

 If I have any questions or concerns, I will address them promptly to the EFT practitioner. I hereby authorize Mori Montagne to provide me with Emotional Freedom Technique and/or Energy Psychology sessions.

 Signature________________________________________      Date ______________

Address (city and state only preferred):______________________________________

Phone ______________________  Email___________________________________


Please copy and paste this form into the link below, fill in your information and send.  This is a secure and protected link. By sending this form with your name entered, you are attesting that you have read, understand, and agree with the statements in the Consent Document, and accept that communication as legal consent for treatment using EFT and Energy Psychology techniques received by me, from now through all future treatments.