Disclaimer & terms of service

Parents and legal guardian consent form

Full name of client under 18

Full name of parent or legal guardian

Email (of parent or legal guardian if client is a minor)

For minors: (minors are those under eighteen years of age)

If you are under eighteen years of age, please be aware that the law may provide your parents or legal guardians the right to access your records. 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 with only general information unless I feel there is a high risk you will seriously harm yourself or someone else. In this case I will notify them of my concern. I can also supply them with a general summary at the conclusion of our working together. However before giving them any information I will discuss the matter with you first, if possible, and do my best to work with any objections you may have about what I plan to discuss.

For parents and legal guardians:

I declare that I am the legal guardian of the child named as the client above and grant permission for EFT sessions with Eve Soemardi. In the interests of my child gaining the most benefit, I waive my legal right to their information so they can develop a trusting relationship with the practitioner. I understand that I can still gain general feedback under these conditions.

Client informed consent

By ticking these boxes I confirm that I have read and fully understand this document. I have explained to the minor I am responsible for and they understand their rights and responsibilities. All questions that I and my charge had have been answered satisfactorily and we both recognise the opportunity now and in the future to discuss any further questions. I agree to the policies, procedures and fees explained herein. I agree to accept EFT services from you and am voluntarily submitting this form.

Date

Client Intake Form

Parents and legal guardian consent form