Private Session Agreement with Robert Gene Smith
Private session agreement exclusively for personal one-on-one sessions.
Robert Gene Smith’s mission is to bring personal performance tools to the attention of others. His quest is a spiritual one and, accordingly, is an ordained minister.
Robert has trained with some of America’s greatest transformational teachers such as Dr. Richard Bandler, co-developer of Neuro-Linguistic Programming (NLP), Gary Craig, developer of Emotional Freedom Technique (EFT) and Dr. Larry Nims, developer of Be Set Free Fast (BSFF). He has taken these powerful systems that work, combining, simplifying and amplifying them to create eutaptics® FasterEFT™. His technique has been highly successful and used by many thousands of people across the world.
Robert is not a psychologist, dietician, medical doctor, or a therapist and has no licensing or accredited certifications or degrees in these fields.
Disclosure, Responsibility Statement & Client Agreement (The “client” is the signer below)
1. I (the client) understand that Robert Gene Smith is not a licensed counselor, psychologist, therapist, medical doctor, nutritionist or any other medical professional, he has no formal training in these fields and he does not portray himself as such.
2. I (the client) accept complete responsibility for my emotional and/or physical wellbeing before, during and after sessions or classes, and I will instruct others I share these techniques with to take the same self-responsibility.
3. I (the client) agree that it is my responsibility to notify my therapist and/or physician prior to using these skills and agree to their supervision, if suggested. I will continue to take all my medications as prescribed and remain under the care of my physician or therapist for any medical, emotional or mental condition for which I am currently being treated or believe I may need treatment.
4. I (the client) will not use these techniques to try to solve a problem where my common sense would tell me it is inappropriate.
5. I (the client) take full responsibility for what I do with these techniques and will hold harmless Robert Gene Smith, or anyone else associated with the techniques, from any claims made by myself, or anyone whom I seek to help.
6. I (the client) understand that the services provided by Robert Gene Smith are limited to education pertaining to my overall well-being. I understand these services may include his physically tapping on my body at various acupressure meridian points. I grant my permission for limited physical contact. I agree to tell him immediately if it causes me any physical discomfort. I understand that these techniques may reveal some problems I had forgotten, but they don’t cause new problems. I understand I can accept or not accept any recommendations and I can terminate our relationship at any time.
7. I (the client) understand that my full identity will NOT be disclosed without my prior consent, if the issues I address during PRIVATE SESSIONS are shared with others in a general way, for the purpose of educating them about these techniques.
8. In the event a private session is recorded in the format of a written document, video or audio media, I (the client) understand that all records are confidential and will be for private use by Robert Gene Smith or made available to me for an additional fee. Any records of private sessions will not be viewed by anyone else without my prior written consent. I (the client) will not record the session without Robert his knowledge and permission.
9. I (the client) understand that I can reschedule my sessions through email@example.com, if done so 48 hours or more prior to the session and that I will not receive a refund if I reschedule less than these 48 hours or if I don’t show up at the time of the session. I (the client) also understand that a session takes two hours and that these two hours begin at the scheduled time of appointment.
10. I (the client) acknowledge that I have read the above agreement and understand it completely. I, therefore, retain Robert G. Smith, as the creator of eutaptics® FasterEFT™, and voluntarily make and grant this Waiver and Assumption of Risk in favor of Robert Gene Smith, Skills to Change Institute Inc, as consideration for monies paid to the Provider.
You must click on the button below to indicate that you have read and understood the above agreement with your information and electronic signature.