Agreement for Participation in Tappy Hour™

TAPPY HOUR™ AGREEMENT and INFORMED CONSENT - please complete to participate in Tappy Hour™

We are so pleased that you will be joining us for Tappy Hour™!  Although we are thrilled to have you with us, we must have this signed form so that you can participate.

  • This is a confidential record and will be kept in this office. Information contained in it will not be released to any person unless authorized by you.

    I understand that attending Tappy Hour™ is not in place of working with a physician, naturopathic doctor, psychologist, therapist, physical therapist or any other health care professional.
  • Tappy Hour Disclosure Agreement
    Cheri Valentine, LLC
    Healing, Coaching & Mentoring Services

    Congratulations on your interest and decision to participate in Tappy Hour™ with me. Although I will share my skills and abilities to support your growth and personal development, my work with you is only a resource. As an intentional and conscious participant in your growth, you will ultimately take all responsibility for and actions related to furthering your transformation, growth and healing on your life’s journey.

    As part of my practice, I offer a type of energy therapy identified as Emotional Freedom Technique (“EFT”). EFT appears to have promising mental, spiritual, and physical health benefits but has yet to be fully researched by the Western academic, medical, and psychological communities. EFT is a relatively new healing approach and the extent of its effectiveness, as well as its risks and benefits, are not fully known. The prevailing premise is that EFT uses the ancient Chinese meridian system to relieve emotional stress and physiological pain and it balances the energy system with a gentle tapping procedure which stimulates designated meridian end points on the face and body.

    By signing this document you understand that EFT could be considered experimental. If you ever have questions or concerns about the nature of the theories and methods I use, including EFT, please feel free to ask me for further resources or references. Any methods I use, including EFT, and energy healing are considered alternative or complementary to healing arts that are licensed by the State of New Hampshire. I am not a psychotherapist, a registered or licensed counselor or a licensed physician nor are my services licensed by the State of New Hampshire.

    Please be advised that in our work together emotional or physical sensations or additional unresolved memories may surface which could be perceived as negative side effects. It is possible to experience some emotional distress and physical sensations related to prior life experiences. The clinical reports from energy therapies such as EFT show no additional side effects when used appropriately. Emotions may continue to arise after a session and you are encouraged to discuss such emotions with me. In addition, previously vivid or traumatic memories may fade. This could adversely impact your ability to provide detailed legal testimony regarding a traumatic incident.

    You agree to take full responsibility for your self-care in the, emotional, mental, physical, and spiritual dimensions of your life.

    Please be advised that EFT, Energy Healing, Coaching, Mentoring or any work we do together are not used to diagnose, treat, cure, or prevent any disease or psychological/mental health disorder. Consequently, EFT, Energy Healing, Coaching, Mentoring or any other work we do together in Tappy Hour™ do not provide medical diagnoses nor do they offer cures; they do not replace health care from medical professionals.

    You agree to consult with your health care provider for any specific medical problems. If you ever have any concerns about the nature of these classes, please feel free to discuss them with me.

    Education and Training
    B.S. In Education from Salem State College
    EFT Training
    Relationship Coach Training
    Strategic Attraction Plan Coaching
    Passion Test Facilitator Training
    Energy Healing Training and Mentoring
    School of Life and Real Experiences
    Ordained Interfaith Minister with the Universal Life Church

    Acknowledgment and Consent to Receive Services
    By signing this document, you agree that I have disclosed to you sufficient information to enable you to decide to undergo or forgo EFT and/or any other energy based treatment methods and other services I offer. You understand that you are freely choosing to take advantage of my EFT, Energy Healing, Coaching, Mentoring or other services and would otherwise have the option of using conventional psychotherapy methods exclusively, provided by a therapist of your choosing. Your consent to this class is given voluntarily, without coercion, and may be withdrawn.

    You represent that you’re competent and able to understand the nature and consequences of the proposed EFT, Energy Healing, Coaching, and/or Mentoring services. You have read and understand the above disclosure about the healing, coaching and mentoring services offered by me and my training and education. You have discussed with me the nature of the services to be provided and you understand that I am not a licensed physician or psychologist and that my services are not licensed by the State of New Hampshire. You understand it is your responsibility to maintain a relationship for yourself with a medical doctor. You have consented to use the services offered by me during Tappy Hour™ and agree to be personally responsible for the fees related to this class.

    By signing in the space provided below, you knowingly, voluntarily, and intelligently assume these risks and agree to release, indemnify, hold harmless and defend Cheri Valentine and Starry Brook Natural Medicine and their agents, consultants, and employees from and against any and all claims which you, or your representatives, may have from for any damage or injury, including but not limited to, personal, emotional, psychological or otherwise, which you might incur as a result of you voluntary decision to participate in the Class. You represent that you’re competent and able to understand the nature and consequences of participating in the Class.