Scope of Practice Notice

I understand that Jeffrey does not offer mental health counseling, assessment, or trauma support. I understand that Jeffrey does not work with people with unstable mental health conditions, for those who are in crisis, or for those who are experiencing substantial active trauma.

I certify that I am not in crisis, that I am in stable mental health, and that I am not experiencing substantial active trauma

I understand and agree that Jeffrey is adjunctive to and not responsible for my healing. I understand and agree that my healing is part of my own sacred journey.

I agree to mindfully engage in my own healing homework practices and regular energetic hygiene maintenance as laid out in our session and aftercare emails to the best of my ability.

Declaration of Existing Support Network

I understand and agree that Jeffrey is not responsible for my long-term support. I certify that I have adequate support fully in place to help me integrate our session.
 

Policies
I understand that 24-hour notice is required to avoid a session fee.
I understand that Jeffrey may consider the session a no-show after ten minutes without contact.
Payments for sessions are rendered at time of service.

I understand that session rates cover Jeffrey’s time and not outcome, and that outcomes cannot be predicted nor guaranteed.

I understand and agree that Jeffrey is not responsible for my long-term support. I certify that I have adequate support fully in place to help me integrate our session.

Informed Consent and Hold Harmless Agreement

I, the electronic signer above affirm that I have read, understood, and agreed to the following statements indicating understanding and consent of the conditions presented: I understand that Jeffrey is not a therapist or medical provider and that this work is not therapy or medical treatment or a substitute for therapy or medical treatment. I understand that this work does not intend to diagnose, treat, or cure disease or mental illness. I understand that this work is not for people experiencing unstable mental health conditions, those who are in crisis, or those with substantive active trauma. I understand that this work is transformative/catalytic and that I am responsible for acquiring the mental health support, aftercare, or integration work needed to process this work, as recommended by Jeffrey or according to my own self-assessment and judgment. I do not hold Jeffrey or Living Energy Technology LCC legally responsible for any physical, emotional, mental, circumstantial, or energetic effects that may occur in connection with my participation in sessions. I recognize and agree that I am fully responsible for my well-being during my session, which includes disclosing any concerns and/or questions I may have before, during, or following my session. I understand that Jeffrey does not guarantee any specific result from session work and that he is unable to predict or control what my outcome may be. In receiving treatment I am willing to assume the risk of this uncertainty. I understand that during a course of session work some symptoms or circumstances may be activated or exacerbated: I may experience new symptoms as layers of work come up for processing, and I may experience an exacerbation of existing symptoms as the work progresses. I understand that usually these states are temporary and resolve with a completion of the work, but that no guarantees can be given about their resolution. With this knowledge, I voluntarily consent to the above procedures and services, realizing that no guarantees have been given to me by Jeffrey regarding the cure or improvement of my conditions. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Jeffrey and Living Energy Technology LCC and all its agents from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with the above-mentioned procedures and services. I understand that I am free to withdraw my consent and to discontinue participating in these services at any time. I understand that Jeffrey may terminate our professional relationship for any reason, and in the event of termination will provide referrals for my continued care.