Jerrica Fritzley Coaching

Bloss-OM LLC Client Consent Form:

Hi & thank you for considering working with me. Please read the whole document thoroughly to better understand EFT & Energy Meditation, the potential risks and benefits of working with these energy healing techniques. If you have any questions please reach out to me by email at: [email protected]. Sign the document only when you have fully understood all aspects of working together. 

Emotional Freedom Technique (EFT) and Energy Meditation are self help techniques. These techniques should be viewed as complementary to working with your therapist and/or physician. 

I do not diagnose or treat disease and I am not a physician or a mental health care provider. These sessions are not a substitute for diagnosis or treatment from a qualified health practitioner for illnesses, injuries, or other mental/medical conditions. My services are not licensed by the state of Idaho.

In the event of a crisis: I do not do crisis work. In the event of a crisis please call 9-1-1, go to your nearest hospital, call a  mental health care provider, or national suicide prevention lifeline (800)-273-8255. If you need a referral for a therapist or counselor, I will do my best to help find a service provider that can best serve you. 

Privacy: Your information will be kept private to the best of my ability. Notes are stored on my computer and deleted after 5 years of working together. My computer is password protected. I will never keep medical records or medical information.  

Serious Threat to Health or Safety: If I believe that you pose a clear and substantial risk of imminent serious harm to yourself or another person, I may disclose your relevant confidential information to public authorities, the potential victim, other professionals, and/or your family to protect against such harm. If you communicate an explicit threat of inflicting imminent and serious physical harm or causing the death of one or more clearly identifiable victims, and I believe you have the intent and ability to carry out the threat, then I may call local authorities in your area. 

Minors: At least one parent or guardian must be involved in the minor child's sessions. Parents commit to a follow-up email after the minors session. At this time the parent(s) may ask questions while also reporting on the minors emotional well being after the session. Often in EFT & Energy Meditation there is a shift in one's nervous system which can leave a person feeling more tired as they integrate the new thought pattern. The minors personal shares will be kept confidential unless there is an immediate threat to the minors life or the information shared becomes out of scope for Jerrica Fritzley. At that time an appropriate referral is needed. Together the parent and practitioner (Jerrica Fritzley) will work to find the best care for the minor. 

Scope of work: If at any point Jerrica Fritzley feels the situation is out of range for her scope of work, a referral will be given to work with a licensed health care provider. In some cases, continuing to work together will be possible while working with a licensed therapist or counselor. Consult with your licensed healthcare provider to make an appropriate decision for the care you need. 

Techniques & Session(s): 

EFT: During a session I work with the client to help identify an issue(s) that the client would like to work on and develop an appropriate “setup” statement. I will then demonstrate and lead  the client through a series of tapping motions on acupressure points on the body, while repeating  the setup statement out loud. The combination of tapping and repeating the setup statement sends a calming signal to the amygdala, a part of the brain associated with the body’s fight and flight response and allows the brain to send calming signals to the rest of the body. The process often promotes a feeling of peace and general well being. EFT combines methods from exposure therapy, Chinese Medicine (acupuncture), and cognitive therapy into one method. 

Energy Meditation:  With Energy Meditation  Clients are guided to connect  with the subtle energy that runs through the body. Connecting with the body’s subtle energy allows the client to harmonize the spirit and body. During this portion of the session the client  simply closes their eyes and observes with the senses through intuition. 

Sessions are up to 60 minutes long, held over an internet platform, currently I am utilizing Zoom.  Depending on how the session is progressing I will/may suggest switching from Tapping to Energy Meditation or vice versa. Prior to termination of the session, I assist the client in feeling grounded and calm.

Benefits and risks: 

Benefits and clinical studies can be found at:  

https://www.eftuniverse.com/research-studies/eft-research

EFT often works quickly to resolve issue(s) that have been identified within just a few sessions. However, this is not always the case and issues may take a few sessions or longer to resolve. 

Tapping can bring clarity and neutrality to an  emotionally charged event. The client may experience feelings of  emotional freedom from the event. 

Emotions may come up as we focus on the negative while inviting acceptance to the situation. It is important to know we may talk about past events, but only as the client is willing and ready to. The end result is often a feeling of peace and resolution as the client is given the opportunity to reprocess a past event from a new mindset. 

You may experience what is often referred to as “off-gassing”  in the form of burping, sneezing, laughing, crying, checking out, getting tired, or perhaps needing to go to the bathroom. This is a sign that the method is working. It often passes quickly.  

Educational Training, credentials, experience: 

Jerrica has studied with a master in Energy Meditation for over 8 years and has assisted for 3 of those years. Jerrica is a certified EFT Practitioner by Sonya Sophia’s School of Living Arts. Currently receiving training in Clinical EFT through EFT Universe with Dawson Church (the co-writer of the EFT manual). Graduate of LYT Yoga 200 hour teacher training program and Triveni Yoga (200 hr YTT graduate). She is a trained mindfulness teacher for youth & has taught kids in the classroom. Jerrica has worked with clients for 4 years. Working with a variety of ages (11-50+).

FEES:   

All fees are due before the session begins and are non refundable. Transactions are done through the secure platform of Kajabi. 

Individual Session: 

Tapping sessions are 60 minutes long $200.00 

Scheduling appointment and Cancellation: 

Sessions are generally 60 minutes long. To schedule, reschedule, or cancel your appointments do so through the online booking system Kajabi. If you cancel an appointment, I require clients to provide notice at least 24 hours before the session or the client pays the session at the clients’ regular rate.  If you are over 15 minutes late, I may cancel your appointment, and no-show fees will apply. I endeavor to begin and end sessions on time. However, in some circumstances, it is necessary to run over the scheduled appointment time. If I run more than 10 minutes late, you have the option to reschedule without penalty. 

I can be reached during office hours through text message at 650-823-8472 or email at [email protected]  in the case an urgent matter arises. Know these modalities are not encrypted and information can be easily obtained by third parties. It is important to only share non-personal information through these channels. 

Booking: 

This session is to be immediately booked and had within 1 months time from purchase date. 

CANCELLATION AND NO-SHOW APPOINTMENTS: You agree to the following:

 To provide at least 24 hours’ notice of cancellation or rescheduling of an appointment. 

 To pay the fee for appointments canceled within 24 hours of the scheduled appointment time. 

 To pay for N0-SHOW APPOINTMENTS at the regular client rate. 

 If you or minor are over 15 minutes late for an appointment, the appointment may be canceled, and the NO-SHOW fee applies. 

STATEMENTS: If you have a payment plan, an invoice will be emailed and made available to you after the first of each month. 

BILLING QUESTIONS: For problems involving payments, please contact me by email at [email protected]

Agreements: 

  I understand that at any time I may end the session. If I am experiencing discomfort, I will verbally tell Jerrica who will then switch the method.  I agree to book and have the session within one months time.  I understand there is an expiration date is after one month from purchase date. 

   I agree I must cancel 24 hours prior to the session or the full price of $ 200.00    for each 60 minute session will be charged or forfeited. 

I have been informed that all client information and records are treated in a confidential manner. My experiences during these sessions are confidential subject to the usual exceptions governed by State or federal laws and regulations. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless both  Bloss-OM LLC and Jerrica Fritzley from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s). My questions have been answered to my satisfaction regarding Jerrica Fritzley’s background, scope of work, and what I might expect from this session. I give my consent to receive EFT and Energy Meditation from Jerrica Fritzley, EFT and Energy Mediation Practitioner.