INFORMED CONSENT - SAMPLE

ENERGY HEALTH COACHING

Energy Health Coaching is a process in which the Coach, Stacy Dorius, is a strategic partner of the Client, you, to explore and shift the resonance of the client’s thoughts, feelings, beliefs and behaviors that challenge, limit or block him/her from their desires, intentions, goals and actions using the methodology of energy psychology, along with energy-based tools and applied neuroscience techniques. It’s a comprehensive process that supports the client to own, change and love their energy.

Energy Health Coaching is client-focused and client-driven with the client choosing their priorities and concrete actions. The coach honors the client as the expert in his/her life, and believes they are creative, resourceful and whole. The client is in the driver’s seat of their own life and invites the coach along as the passenger to partner with them in achieving their life vision using an energy-based approach.

The coach serves to provide the optimal space for self-awareness and self-healing, bring an energetic perspective, create focus, clarify intention, motivate, and build accountability through empowering the client strategically while facilitating the energy-based tools and methodology needed to shift resonance.

To make a coaching relationship successful, the client agrees to:

• Arrive at the scheduled session on-time (either via zoom or phone).
• Give at least a 24 hour notice if they need to reschedule, otherwise they will be charged for the session.
• Show up for the coaching session ready, willing, and prepared for a transformative session.
• Take 100% responsibility for their energy and resonance - thoughts, feelings, beliefs and behaviors.
• Be open to learning, growing and exploring new possibilities.
• Be willing to smile, laugh and enjoy the process, even if addressing heavy issues.
• Be committed to taking concrete actions that support their desires, intentions and goals.

 

ENERGY PSYCHOLOGY

Energy Psychology applies principles and techniques for working with the body’s physical energies to facilitate desired changes in emotions, thoughts, beliefs, and behaviors. It’s an umbrella term for numerous specific approaches and modalities, such as Resonance Repatterning, Healing the Family System, Emotional Freedom Technique, Tapas Acupressure Technique, and Energy Diagnostic Methods (ie, Kinesiology). 

For a list of training and tools used by the coach, go to: https://simplyresonate.com/energy-boss-street-cred/

Working with the human energy system can affect the mind-body interconnection - the thoughts you have, the feelings you emote, the beliefs you hold, the actions you take. Clinical experience and scientific studies confirm that these approaches can assist in addressing psychological conditions such as anxiety, phobias and trauma as well as enhance relaxation, increase a sense of well-being and reduce emotional pain.

There are currently no known side-effects to an energy-oriented approach when properly facilitated by an experienced practitioner.

Be advised of the following:

• Previous emotional reactions to past memories, experiences or traumas may fade and neutralize. This may impact how one provides detailed legal testimony regarding a past incident.
• Responses, including emotional or physical sensations, may surface during a session that neither the coach or client may fully anticipate, and energy-based tools and techniques are used to address them.
• Emotional material may continue to surface after a session and give indication of vibrational resonance related to other events that may need to be addressed in a future session.
• Coach may refer client to practitioners who have specific skills to help with the problem areas that have been identified which are outside of the coach’s expertise.
• For in-person sessions, light touch may be involved to facilitate certain modalities and/or use clinical kinesiology (muscle checking), for which the client can choose to give permission or not.
• Client will be learning how to facilitate personal self-realization, self-regulation and self-resolution by working with his/her own energy system.

 

CODE OF ETHICS

The client understands that the coach is not an attorney, an accountant, a therapist, a psychologist, nor a medical doctor, and does not give advice, medical, legal, tax, accounting or other outside of the scope of coaching expertise, training and knowledge. The client is hereby advised to seek outside professional advice or assistance as they may deem appropriate.

Client Focused: The coach recognizes that each client is a competent person with the right and capability to determine their own priorities, goals and action steps. The coaching process is focused on empowering the client. Each client chooses when to enter a coaching relationship, communicates in a way that is comfortable to them, chooses their primary focus during coaching, and chooses when to end the coaching relationship.

Confidentiality: The coach ensures all coaching sessions are private, and the confidentiality of the client is protected by the coach; records, notes and files are kept private and the coach does not discuss without permission from the client the content of client sessions. For training purposes, general examples that do not allow for identification of a client are used. A coach must disclose information brought to his/her attention that an elderly person, or a person with disabilities, or a child under the age of eighteen (18) has been physically abused or neglected, or if there is a threat of harm to oneself or another.

When working with multiple members of the same family, the coach does not / will not keep secrets (for example: infidelity, substance abuse, self-harm). If there’s something one client (family member) reveals to the coach that directly affects the ability for another client (family member) to own or change their participation in the relationship, then the following will be recommended:

• The coaching session is used to identify the limiting thoughts, feelings, behaviors keeping the client from revealing the secret to the affected family member and a concrete action is identified to resolve this issue with said family member.
• A group session may be scheduled with both clients (affected family members) to openly discuss the secret and move towards resolution.
• If the client is unwilling to reveal the secret to the affected family member, the coach shall end the relationship, and may refer the client to a different practitioner or coach to seek support.

Scope of Process: The coach recognizes that the coaching process is different in nature from mental health services and coaching does not cross over into mental health services through the use of analyzing, assessing, diagnosing, or giving advice. The coach clearly communicates the nature of coaching to the client and maintains clear boundaries. The client is fully empowered through coaching to determine their own best course of action. The coach shall end the coaching process if it is reasonably concluded that the client’s needs are outside the scope of the coach’s expertise.

Integrity: The coach conducts themselves with integrity at all times. The coach sets and maintains clear and moral personal boundaries, treats the client and their information with confidentiality and respect, and ensures consistency in their behavior, treatment of clients, and communication.

Respect: The coach fully respects their client by ensuring client self-determination, clear communication, confidentiality, moral personal boundaries, and consistent treatment. The coach respects and honors their client’s time by setting and keeping appointments, establishing clear boundaries for communication between appointments, clearly communicating rates, payment process and commitment timelines, and treating their client with positive esteem.

Honesty: The coach is truthful in all communications, public and private, verbal and written, both in intent and providing information.

Cancellations: 24-hour notice is required for cancellations; otherwise, the client will be charged full price for their session. The coach provides several opportunities through email confirmations for the client to reschedule their session in advance of the 24-hour cancellation policy.