Informed Consent for EFT/Coaching Services
  • Informed Consent for EFT/Coaching Services

    Please review the information below and provide your consent to participate in EFT and coaching sessions with Clarymond Hardt.
  • Practitioner Information

  • Clarymond Hardt — Certified EFT Professional, Stress & Transformation Coach
    Phone: (310) 403 4772
    Email: clarymond@mothercorps.com
  • Client Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Introduction
  • Please read this form carefully before your first session. It explains how coaching and Emotional Freedom Techniques (EFT) work, what you can expect, and your rights as a client.
  • Practitioner Qualifications
  • Clarymond Hardt is a Certified EFT (Emotional Freedom Techniques) Professional (TMA & NOVET), Matrix Reimprinting Practitioner (TMA), and Mystical Shamanism Practitioner. She has studied yoga, meditation, nutrition, ketosis, fasting, circadian rhythm, and energy medicine for over 20 years to support holistic health and healing.
  • Nature of Coaching and EFT
  • Coaching is a collaborative process that supports personal growth, stress reduction, and self-discovery. It is not psychotherapy or medical treatment. EFT (“tapping”) is a science-backed, evidence-based self-help method involving gentle tapping on meridian points while focusing on thoughts or emotions.
  • How Sessions Work
  • Sessions are conducted via Zoom, Brave Talk, or phone. No account is needed for Zoom. Please sit in a well-lit, private space where you won’t be interrupted. Arrive a few minutes early to log in and get settled, as you would for an in-person appointment.
  • Scope of Practice
  • Clarymond Hardt is not a licensed medical or mental health professional and provides EFT, Matrix Reimprinting, and related practices as educational and coaching services only. These services are not intended to diagnose, treat, or cure any medical or psychological condition. Clients are advised to consult with a licensed healthcare provider regarding any medical or mental health concerns and not to discontinue or modify any prescribed treatment without such consultation.
  • Risks and Emotional Effects
  • Sessions may involve exploring past experiences and emotions, which can at times feel uncomfortable or bring up unexpected feelings or physical sensations. Emotional material may continue to arise after a session and may require further processing. Results vary and no specific outcomes are guaranteed.
  • Confidentiality
    • All information shared during sessions is kept confidential and will not be disclosed without written consent, except as required by law, including:
    • Risk of harm to self or others
    • Suspected abuse or neglect of a child, elder, or dependent adult
    • Legal obligation under a valid court order
    Non-identifying information may be shared with professional mentors or colleagues for supervision or training purposes.
  • Client Responsibilities
  • Clients are fully responsible for their physical, emotional, and mental well-being during and after sessions. Results depend on the client’s participation, consistency, and willingness to engage in the process.
  • Sessions and Fees
    • Each session lasts 60 minutes.
    • Fees:
    • 1 Session – $200
    • 3 Sessions – $550
    • 6 Sessions – $1,050
    • 12 Sessions – $1,995
    • 48 Sessions (Year-Long Coaching Program) – $7,000
    Longer-term packages provide consistent support and tend to produce the most meaningful results.
  • Cancellation Policy
  • Cancellations require 24-hour notice. Sessions not canceled within this timeframe will be charged in full.
  • Refund Policy
  • All coaching sessions and packages are non-refundable once purchased. If you are unable to continue, any unused sessions may be applied as a credit toward future sessions within 12 months. Exceptions may be made in cases of medical or personal emergency, at the sole discretion of Clarymond Hardt.
  • Consent and Acknowledgement

  • Client Acknowledgement

  • Date*
     - -
  • For Clients Under 18

  • Parent/Guardian Date
     - -
  • Disclaimer
  • These services are educational and coaching-based in nature. They are not intended to diagnose, treat, or replace any medical or psychological condition, nor do they substitute for licensed healthcare or mental-health treatment. If you are currently under medical or psychological care, please continue that treatment and inform your provider about your participation in EFT.
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