PERMISSION & AUTHORIZATION FORM REGARDING THE USE OF
Emotional Freedom Techniques (EFT)
PLEASE READ BEFORE SIGNING (by clicking on the "I Accept" button) and submitting
I specifically authorize Rossanna M. Massey, D.C., EFTCert-II to use the techniques collectively known as E.F.T. (Emotional Freedom Techniques), and I acknowledge that I am voluntarily attending and participating in E.F.T. sessions for educational purposes, and not for the treatment, or "cure" of any disease or condition as defined by the medical or psychological communities.
I understand that EFT (Emotional Freedom Techniques) is a member of a new class of treatment techniques and protocols referred to as Energy Therapy. While still considered experimental, these techniques are being used by therapists, physicians, nurses, psychiatrists and lay people worldwide. While there are theories as to how they work, why they work, and why they sometimes don't work, there is no accepted scientific explanation. As a result of their experimental nature, no EFT practitioner knows with certainty in advance how someone can be helped or if the techniques will help a particular person with a particular problem.
I agree to accept full responsibility for my emotional and physical health. I assume and accept the risk of any adverse outcome that might result from using the techniques learned or used. I recognize that the practitioners at the Freedom To Succeed Center do not recommend that I, or any person with whom I may use the techniques, stop using any prescribed medicine or other therapy that I or he/she may be using, without consulting my or his/her doctor, even if the techniques appears to indicate that such medicine or therapy is unnecessary. To date, EFT has yielded exceptional results, however, these techniques are NOT meant to replace appropriate health care professional treatment or mental health counseling. I further understand that Dr. Rossanna M. Massey may record all or portions of our EFT sessions for educational and research purposes and that my name and identity will not be included on such recordings nor revealed without my express written permission. This is for several reasons: (1) In order to help you get the maximum benefits from your sessions and to assist you in recognizing the extent of the improvements you obtain by providing you with a copy of the recorded session for your review and assimilation (2) and also as part of our ongoing studies to improve and refine our own skills, (3) and for providing material and examples of the application of EFT for articles and other publications, including digital audio files. I further understand that at no time will my name or real identity be used in conjunction with said publications.
No promise or guarantee has been made regarding the results of E.F.T., but rather I understand that E.F.T. is a means by which the body's subtle energies can be used as an aid to eliminating or reducing possible negative emotional imbalances, so that safe natural programs can be developed for the purpose of bringing about an empowerment of my performance potentials in the areas of physical, emotional and spiritual health.
I have read and understand the foregoing.
This permission form also applies to subsequent visits and consultations.
After clicking on the "submit" button on the next page, you will be taken to the Payment Page.
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