This document contains important information about my professional services and business policies. It covers a wide range of possible situations, some of which may not apply to you. Still, it provides a framework for understanding the services you are considering. Please read it carefully and note any questions you might have. We can discuss them at our next meeting. If you decide to use my services and sign this document on the signature page, it will represent an agreement between us.
EDUCATION, TRAINING & APPROACH
I am the owner of Life in Balance Ayurvedic Rejuvenation Center. I have been practicing alternative healing therapies and energy medicine for over 20 years. I am an Accredited Certified EFT Practitioner through EFT International.
My work focuses on the integral connection between the mind, body, spirit and emotions. I have found that EFT Tapping most effectively facilitates physical and emotional healing by getting at the deep emotional root of the issue. I am committed to bringing my clients to the place of experiencing love and acceptance for themselves and living joyfully; awake and fulfilled in the difference they make in their communities and the world.
WHAT IS EFT (EMOTIONAL FREEDOM TECHNIQUE) TAPPING?
EFT is an approach that involves balancing and restoring your body’s natural energies for the purposes of increasing your vitality, strengthening your mental capacities, and optimizing your health. The form I use is Clinical EFT, the method validated in many research studies which shows it to be an evidence-based practice. Gentle tapping stimulation of acupressure points located on the surface of the face and body, paired with mental activation of unwanted emotional content or desired outcomes can shift the brain’s electrochemistry to:
• help overcome anxiousness, fear, guilt, shame, jealousy, or anger
• change unwanted habits and behaviors
• replace negative thoughts with life enhancing ones
• relieve the emotional contributors to physical pain
• enhance the ability to love, succeed, and enjoy life.
Tapping gently on specific meridian points on the face and body for physical and emotional issues are intended to complement, not replace, medical or psychological care. Results will vary from person to person. Because these methods are relatively new, the extent and breadth of their effectiveness, including risks and benefits are not fully known.
• The intensity of previously vivid or traumatic memories may diminish. This could adversely impact the ability to provide legal testimony regarding a traumatic incident
• Reactions may surface during sessions that are unanticipated, including strong emotional or physical sensations or additional unresolved memories
• Emotional material may continue to surface after a session and give indication of other incidents that may need to be addressed
The EFT techniques I will be using and teaching you are based on the premise that by promoting balance and flow in the body’s electromagnetic and subtle energies, health and well-being are enhanced. The methods we will be using lend themselves to individualized applications in the office, via Zoom and at home for personal work and self-care. EFT is a self-regulating technique or self-help tool that you can use whenever and wherever you choose, and you are not dependent on another person to practice it successfully.
SESSIONS
I generally schedule one session, 60-minute duration per week, at a time we agree upon. Sessions may also, by prior agreement, be more frequent, or less frequent. Your schedule will be determined by what package of services you may invest in and what we agree upon for duration and frequency.
PROFESSIONAL RECORDS
YI keep brief records on each session, primarily noting the date of the session, the techniques used and progress or obstacles observed as they relate to your goals in working with me. I maintain your records in a secure location. I may maintain your records for three years after our last contact, after which time I may securely dispose of them.
CONFIDENTIALITY & CLIENTS RIGHTS
You have the right to the confidentiality of your therapy.
- I will not tell anyone else what you have told me, or even that you are in therapy with me, without your prior written permission.
- Your confidentiality is also protected under provisions of the Federal Health Insurance Portability and Accountability Act (HIPAA), which are discussed in the Notice of Privacy Practices form that I have asked you to read and sign in addition to this form.
Our communications are confidential. No information will be given to anyone without your explicit written consent. Exceptions to confidentiality include the following:
- My participation in mentor/professional consultation for further development. In these consultations, your identity will not be revealed and the consultant is also bound to keep the information confidential.
- If I believe that you may be a danger to yourself or others, I will do whatever I can to try to prevent harm.
- If you tell me about the knowledge or suspicion of abuse of minors, developmentally disabled people, or dependent elders, I must report it.
- If a court requires me to disclose information, I must comply with the court order.
- If you tell me about the unprofessional conduct (e.g., sexual misconduct) or impaired judgment of a health care professional, I must report it.
If one of these conditions exists, I will try to talk with you before contacting the relevant authorities.
MINORS
If you are under 14 years of age, please be aware that your parents or legal guardians have the right to examine my records of our work together. It is my policy to request a written agreement from parents to waive their right to access your records. If they agree, I will provide them only with general information about our work together unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concern. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have about what I am planning to discuss.
PROFESSIONAL FEES
Average sessions run 60 minutes (unless otherwise agreed)
- 4 x 60-minute sessions package $600.
- 6 x 60-minute session package $800
- 75-minute individual session for established clients $175
Payment may be made by credit card or Venmo for Zoom sessions. In person sessions may be paid for in cash, by check or Venmo at the time of service. Venmo payments @kael-balizer.
NEW CLIENT DISCOVERY CALL
We will begin our work together with a 45-minute Discovery Call. This call is designed to clarify your goals, gather client history, and create a safe working foundation. The Discovery Call will be the first call in your package. If during this session, I determine that I am unable to help you with your issue, I will terminate our working relationship, refund you the entire package amount, and refer you to another practitioner.
PAYMENT
You will be expected to pay for each session at the time it is held unless we agree otherwise or you have purchased a package, in which case payment will be made in full by the first session, unless payment arrangements are made prior to beginning sessions or otherwise agreed.
SCHEDULING & CANCELLATION POLICY
I check my email and voicemail on my workdays -- Mondays, Wednesdays, and Thursdays. We can schedule appointments during our appointments, by e-mail or you can schedule on my website.
If you can’t attend an appointment, please let me know by email or phone, ideally with at least 48 hours’ notice, so that I can offer the spot to another client.
If you cancel your appointment with less than 24 hours’ notice you will be charged the full session fee for the missed appointment, with the exception of if you become sick or there are unusual circumstances beyond your control. If you are late for an appointment, we will probably have a more limited time to meet.
QUESTIONS & SUPPORT BETWEEN SESSIONS
If you have questions or need support between sessions, please email me and I will be happy to respond to your email and send suggestions. If you need further support, I will gladly schedule an extra appointment for you at the next available session.
OTHER ASPECTS OF OUR RELATIONSHIP
You can always ask me questions about anything that happens in our work together. I’m always willing to discuss how and why I’ve decided to do what I am doing and to look at alternatives that might work better. You can feel free to ask me to try something that you think will be helpful. You can ask me about my training for working with your concerns and can request that I refer you to someone else if you decide I’m not the right coach/practitioner for you. You are free to terminate our work together at any time.
TOUCH - Most of my coaching sessions are done via Zoom. If we are doing in-person sessions, you may be asked if I have your permission to do some of the tapping on your hand, face and collarbone or you may do this yourself. If you become uncomfortable with being touched or with any of the procedures being used, please tell me at any time and I will stop immediately.
TERMINATING THE SESSIONS: Normally, you will be the one who decides when our work will end, but there are three exceptions to this. If I determine that I am unable, for any reason, to provide you with the services you are requesting at a high professional standard, I will inform you of this decision and refer you to another practitioner, or to a health care provider who may better meet your needs. Second, if you verbally or physically threaten or harass me, my office, or my family, I reserve the right to terminate you from my practice immediately and unilaterally. Third, I reserve the right to refuse or terminate a session if you or anyone in the session is suspected of being under the influence of a mood-altering substance. You will be responsible and charged for the full payment of the normal fee.
VACATIONS: I am away from the office several times each year for vacations, or to teach. I will make every effort to tell you well in advance of any anticipated lengthy absences and to discuss other options for continuing to work toward your goals during my absence.
COMPLAINTS: If you are unhappy with the way our work together is proceeding, or if I ever say or do something that upsets you or doesn't feel right, please bring it up and talk about it with me so I can respond directly to your concerns. I will take such concerns seriously and meet them with care and respect.
CLIENT/COACH AGREEMENT
Many of my policies and procedures are cited in the Informed Consent document above but below explains a little bit more about what I expect of you as a client so that there are no misunderstandings of how we will be working together.
In the text below, the term "client" refers to you and the term "coach" refers to Kael Balizer. If there is anything you do not fully understand in any part of this document, please ask me about it so that we may begin our relationship in an open, honest manner.
1. As a client, I understand that Kael Balizer is an Emotional Freedom Techniques (EFT) Coach, not a medical professional, physician or therapist and is not licensed to diagnose or treat any physical or mental illness. Although EFT uses the term “emotional,” it does not imply that EFT practitioners are practicing therapy.
2. I understand that EFT coaching will include Emotional Freedom Techniques used in all of the coaching sessions, as requested.
3. I understand and agree to meet my coach at the scheduled time. I will come to the call/Zoom meeting with updates, progress and current challenges and will let my coach know what I want to work on and be ready to be coached. I understand that the agenda is client-generated and coach-supported.
4. As a client, I understand and agree that I am fully responsible for my well-being during my coaching sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time. I recognize that coaching is not psychotherapy and that professional referrals will be given if needed.
5. I understand that "EFT coaching" is a relationship I have with my coach that is designed to facilitate the creations/development of personal, professional or business goals and to develop and carry out a strategy/plan for achieving those goals. I acknowledge that deciding how to handle these issues and implement my choices is exclusively my responsibility.
6. I understand that EFT coaching does not treat mental disorders as defined by the American Psychiatric Association. I understand that EFT coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment; and I will not use it in place of any form of therapy.
7. I promise that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with this person regarding the advisability of working with an EFT coach and that this person is aware of my decision to proceed with the EFT coaching relationship. Likewise, I have advised my coach of any kind of mental health or physical therapy that I may currently be involved in.
8. I understand that any information discussed with Coach/Practitioner will be kept in strict confidence, except as released by client, and accept as required by law and discussed previously in this document. Coach/Practitioner may audio record sessions for transcription for educational review. Unless otherwise requested by client, real names will not be used in transcriptions. Certain topics may be anonymously shared with other EFT coaching professionals for training or consultation purposes.
9. I or my representative(s) agree to fully release and hold harmless Kael Balizer from and against any and all claims or liability of whatsoever kind or nature, real and implied, arising out of or in connection with my sessions.
Your signature below indicates that you have read the information in all sections of this document, understand the content fully, have discussed any questions or matters of concern with me and/or others, and agree to abide by its terms during our professional relationship.
By signing this form I agree to the terns and conditions of this agreement.