Consent Form

understand that I am voluntarily participating in one or more of the following experiential

modalities:

• Integrative Coaching
• NLP-Neuro-Linguistic Programming 
• MER – Mental Emotional Release Therapy
• Hypnotherapy / guided visualization
• Relaxation, imagery, and focused awareness techniques
• All Services to be paid in full, in advance of service’s rendered. (Unless otherwise agreed upon.) –Initials--

These approaches are designed to support personal insight, emotional regulation, self-awareness, and behavioral change, Scope and Limitations.

I understand and acknowledge that:

• These services are not medical, psychological, or psychiatric treatment
• They do not diagnose, treat, or cure any disease or mental health condition
• They are not a substitute for medical care, psychotherapy, or medication
• Initials--

If I am under the care of a licensed medical or mental health professional, I am encouraged to continue that care.

Required: Provide a release form from said Provider.

Emotional and Experiential Awareness

I understand that participation may involve:

• Emotional release or recall.
• Shifts in awareness, perception, or perspective.
• Temporary emotional discomfort as part of the change process.
• With insights related to beliefs, habits, memories, or patterns in life Strategies.

Voluntary Participation:

I acknowledge that I may pause, stop, or request grounding at any time during a session.

Client Responsibility

• I understand and agree to commit 100% to the process and that:
• Results vary from person to person.
• No specific outcome is guaranteed.
• My results depend on my participation, openness, and integration.
• I am responsible for my own decisions, actions, and well-being.

I affirm that:

My participation is entirely voluntary.

I may withdraw consent at any time without penalty.

I have had the opportunity to ask questions and receive clarification–

Initials--

Confidentiality

I understand that all sessions are confidential within the limits of the law, including but not limited to:

• Risk of harm to self or others
• Abuse or neglect disclosures as required by law –Initials--

By signing below, I confirm that:

• I have read and understand this Informed Consent Form.
• I agree to participate 100% in Integrative Coaching, NLP, MER Therapy, and/or Hypnotherapy sessions
• I accept full responsibility for my participation.

Practitioner Acknowledgment

I confirm that I have explained the nature of these services and answered any questions to th