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Disclosure Statement and Client Informed Consent
for EFT Consulting Services by Jennifer O’Keefe of Glikstorm LLC

Emotional Freedom Technique (EFT)

I offer a type of energy therapy identified as Emotional Freedom Technique (EFT). EFT uses the ancient Chinese meridian system to relieve emotional stress and physiological pain. EFT balances the energy system with a gentle tapping procedure which stimulates designated meridian end points on the face and body. EFT appears to have promising mental, spiritual, and physical health benefits but has yet to be fully researched by the Western academic, medical, and psychological communities. The extent of EFT’s effectiveness, as well as its risks and benefits, are not fully known. EFT is considered alternative or complementary to healing arts that are licensed by the State of New Hampshire.

Training

I am an Accredited Certified EFT Practitioner. EFT is considered to be alternative or complementary to healing arts that are licensed by the State of New Hampshire. I am not a psychotherapist, a registered or licensed counselor, a licensed physician, nor are my services licensed by the State of New Hampshire.

I am also a certified Canfield Trainer, authorized to teach "The Success Principles" by Jack Canfield, and a certified BodyTalk Access Technician.

Side Effects

As we work together with EFT, emotional or physical sensations or additional unresolved memories may surface which could be perceived as negative side effects. It is possible to experience some emotional distress and physical sensations related to prior life experiences. Emotions may continue to arise after an EFT session, and you are encouraged to discuss such emotions with me.  Through EFT, some of your previously vivid or traumatic memories may fade. This could adversely impact your ability to provide detailed legal testimony regarding a traumatic incident.  The clinical reports from energy therapies such as EFT show no additional side-effects when used appropriately.

Outcome

There is no warranty, guarantee, or prediction regarding the outcome of an individual using EFT for any particular issue.

Responsibility

Our work together will include a shared understanding of what you hope to accomplish and agreements for supporting those outcomes. Although I will share my skills and abilities to support your growth and personal development, my work with you is only a resource. As an intentional and conscious participant in your growth, you will ultimately take all responsibility for and actions related to furthering your life journey. You agree to take full responsibility for your self-care in the emotional, mental, physical, and spiritual dimensions of your life and to seek professional advice as appropriate before making any health decisions.

Not Medical Care

Please be advised that EFT is not used to diagnose, treat, cure, or prevent any disease or psychological/mental health disorder. EFT sessions do not provide medical diagnosis, nor do they offer cures; they do not replace health care from medical professionals. You agree to consult with your health care provider for any specific medical problems. You are advised to continue any physical or psychological treatment that you’re currently receiving and to inform your health care providers about participating in EFT sessions.

Acknowledgment and Consent to Receive Services

You agree that I have disclosed sufficient information to enable you to decide to undergo or forgo EFT. You understand that you are freely choosing to take advantage of my EFT services and would otherwise have the option of using conventional psychotherapy methods exclusively, provided by a therapist of your choosing. It is your responsibility to maintain a relationship for yourself with a medical doctor. Your consent to this course of treatment is given voluntarily, without coercion, and may be withdrawn. You consent to use the services offered by me and agree to be personally responsible for the fees related to the services provided by me to you.

You agree to fully release and hold harmless, Jennifer O’Keefe and Glikstorm LLC from any and all claims or liability whatsoever and for any damage or injury, including but not limited to, personal, emotional, psychological or otherwise, which you might incur as a result of your voluntary decision to participate in EFT.  You represent that you are at least eighteen years old, competent, and able to understand the nature and consequences of participating in EFT.  By signing below, you acknowledge that you have read and agree to this Disclosure Statement and Client Informed Consent.

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Contact Us:

Jennifer O'Keefe - Jen@Glikstorm.com

(603) 943-6480 please leave a voicemail & we will respond quickly

Mailing Address: Glikstorm LLC, 11 Wood Hawk Way, Litchfield, NH 03052

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