Client Disclosure - Monthly Maintenance

Before we begin, please read this agreement and then sign and date it. This will let us know that you have read and understand what is written here. This form will ask you about your present condition for which you seek therapy as well as any other issues you might have. It also sets out the context in which you will get the outcome you want. It also covers some of the issues of law governing our relationship. Some of these items may not apply to your coaching program.

  1. What to Expect. Your alternative health care practitioner has been trained and certified in Mental and Emotional Release® at the Master Practitioner level and will be doing this technique along with Neuro Linguistic Programming (NLP). The therapy will probably be different from what you might have expected. In total, we will not spend a lot of time talking about the problem, just gathering information about it. In fact, most of the session (s) are about other things.

It is very important for us to discover the internal thought process of HOW you create the problem. That means that we are looking for your strategy, or how you structure the problem. Because our focus is on structure, that means that, once we discover it, we can move on and focus on having the problem disappear very quickly.

Because of this, your Alternative or Complementary Health Care and Therapy Master Practitioner may cut short your answers or event talk about your problem in ways that you have never considered. She may even ask you questions that you do not totally understand consciously in order for your Unconscious Mind to make the changes you want at the unconscious level. It is important to do this so that we can reduce the time taken for the therapeutic process.

If you have been in a therapy session before, expect that this one will be very different, and quite a bit shorter.

  1. This is the process: We begin with you telling us the problem. We will ask you for examples of the problem and other questions to discover HOW you do it in your head. We will also probe to discover the source of the problem – the precipitating event (s). Sometime before the end of this part of the session we will ask you what has to happen so you will know the problem is gone.
  2. After the session: We will probably assign you some very specific tasks to do. If assigned these tasks are, absolutely, a fundamental part of the therapy. They may take up to several days or weeks to complete. The tasks are directly related to the circumstances that created the problem. You must do them. If you do not, then neither you nor we can predict the outcome of the therapy. Certainly, any guarantees will not be valid if you do not do the tasking.

The second thing that is important is that you will need to stubbornly focus on what you want. The people who are the happiest over-all in life are those who recognize that you have a choice to focus on what you don’t want or do want. You can focus on negative emotions and things that make you feel bad, or you can focus on positive emotions and things that make you feel good. It is your choice. After the session, you must focus on what you want.

Finally, if your old pattern rears its ugly head, then you must refuse to run that pattern again. Please remember that we have the utmost total and complete respect for you and absolutely no respect for your old problem.

    1. This is Alternative or Complementary Health Care and Therapy: Your Mental and Emotional Release® Master Practitioner is a legal Complementary Healthcare Provider, and not a licensed Medical Doctor, Psychiatrist, Psychologist, Master’s in Family and Child Counseling, or a Master’s in Social Work. The services you receive are not licensed in this state, nor are they regulated by a governmental body. The self-regulated holistic treatments and client-centered disciplines in which your practitioner is trained and in which he/she has experience, include, consulting and coaching, Mental and Emotional Release®, Neuro Linguistic Programming (NLP). We will always provide only those services in which we have been trained, and if we find that we cannot help you, we will refer you to a licensed person who an assist you.
    2. Confidentiality: We keep all information we receive from you, confidential, and do not disclose it to persons outside our company. All client information is kept strictly confidential and is for our internal use only. (Importantly, we are required in some states to share information about child abuse with state bodies who oversee such matters).
    3. If you have experienced trauma in your life, you must bring it to the attention of your practitioner and furnish a letter of consent from a medical provider before beginning. It will be up to your Master Practitioner to proceed with the alternative therapy.
    4. If you are, please present a letter of referral from that licensed professional before we start therapy. If you have been prescribed medication to take by that licensed professional, you need to present us a letter of consent from that person before we start therapy. (This means a short-written note stating that you have informed your health care provider of your decision to engage in Alternative or Complementary Health Care and Therapy). Furthermore, nothing that happens here in therapy should be construed as, nor should you believe that it is a substitute for the advice of a licensed person.
    5. Your Choice, Your Responsibility: While, during the session, we will offer you advice and other ways of looking at your problem and its solutions for your consideration. You hereby agree that whatever we discuss is only our perspective and is not binding upon you, nor is it a prescription. If you want to discuss our suggestions with someone else, you should discuss them with a licensed health care provider. It is your responsibility to confirm whether or not any changes we made produced the desired results. It is your responsibility to communicate your results to us. Our liability is limited to the amount paid for the therapy.


    1. Mental and Emotional Release®: The techniques are a process of active imagination where the client imagines floating above his/her timeline and letting go of his/her negative emotions and/or limiting beliefs. Then the client is also asked to imagine creating events in his/her future that support his/her goals or outcomes. Mental and Emotional Release® has demonstrated results in a broad variety of presenting problems. It is a powerful technique which allows clients to make long-lasting changes in a very rapid way. Your practitioner is certified as a Mental and Emotional Release® Master Practitioner by the Association of Integrative Psychology.
    2. Neuro Linguistic Programming (NLP): NLP is a model of communication – how we communicate to self and others – and how that communication creates and affects our behavior. As a study, it is a synthesis of cognitive and behavioral philosophies which focus on the information coming in through the neurology (cognitive) and the programs we run inside our heads to produce the behaviors (behavioral) we do. Your practitioner is certified as an NLP Master Practitioner by the Association of Integrative Psychology.

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Signed by Karen Brown
Signed On: January 24, 2019

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Document name: Client Disclosure - Monthly Maintenance
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January 24, 2019 5:36 pm GMTClient Disclosure - Monthly Maintenance Uploaded by Karen Brown - IP