Terms & Conditions - Part 1
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Coaching Agreement: This Coaching Agreement (the “Agreement”) is entered into on the day signed online in DrChrono’s onpatient portal (the “Effective Date”) or the dates signed on the last page, by and between Body Mind Soul Coaching, LLC (the “Coach”) and myself (the “Client”), collectively “the Parties.”
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Purpose of the Agreement: The purpose of this Agreement is to develop a coaching relationship between the Parties in order to cultivate the Client’s personal, professional, and/or business goals and create a plan to carry out those goals through stimulating and creative interactions with the ultimate result of maximizing the Client’s personal and/or professional potential (“Coaching Services”).
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The Parties agree as follows:
1 Coach-Client Relationship – Duties & Responsibilities. A business and/or life coaching relationship is a partnership between two or more individuals or entities. This relationship is not a legal partnership, instead more like a teacher-student or coach-athlete relationship. Each Party must uphold its obligations for the coaching relationship to be successful.
1.1 The Client agrees to communicate honestly, be open to feedback and suggestions, and to fully engage and devote oneself to the coaching process.
1.2 The Client acknowledges and agrees that coaching is a comprehensive process that may explore different areas of the Client’s life, including work, finances, health and relationships, but it is ultimately the Client’s decision how the Client incorporates coaching into each aspect of life.
1.3 The Client is solely responsible for implementing the techniques discovered through coaching.
2 Cancellation Policy. The Client agrees to notify Coach 48 hours in advance of any scheduled session that Client needs to cancel. Coach reserves the right to charge the Client for the scheduled session for a missed/canceled meeting.
3 Termination of Agreement. Either party may terminate this Agreement at any time upon written notice to the other party.
4 Limited Liability. In no event shall the Coach be liable to the Client for any indirect, consequential, or special damages. Notwithstanding any damages that the Client may incur, the Coach’s entire liability under this Agreement, and the Client’s exclusive remedy, shall be limited to the amount actually paid by the Client to the Coach under this Agreement for all coaching services rendered through and including the termination date. The Client agrees that the Coach is not liable or responsible for any actions or inactions, or for any direct or indirect result of any services provided by the Coach.
5 Entire Agreement. This document reflects the entire agreement between the Coach and the Client and reflects a complete understanding of the Parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered, or supplemented except in writing signed by both the Coach and the Client.
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6 Applicable Law. This Agreement shall be governed and construed in accordance with the laws of the state where both Parties reside, without giving effect to any conflicts of laws provisions. If the Parties reside in different states, this Agreement shall be governed and construed in accordance with the laws of the State of California, without giving effect to any conflicts of laws provisions.
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Terms & Conditions - Part 2
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Client: Before we begin, please read this agreement and then sign and date it. This will let us know that you have read and that you understand what is written here. This form sets out the context in which you will get the outcome you want. It also covers some of the issues of law governing our relationship.
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1. Mental and Emotional Release® is alternative or complementary health care under the laws of a number of states: The person you will be working with is not licensed. That means that he/she is not a Medical Doctor, psychiatrist, psychologist, Licensed Marriage and Family Therapist (LMFT), Master’s in Family and Child Counseling (MFCC), or a Master’s in Social Work (MSW), and you acknowledge that you have never worked with a licensed person on this problem. (If you have, you need to present us with a letter of referral from that licensed professional before we start therapy. If you have been prescribed medication to take by that licensed professional, you need to present us with a letter of consent from that person before we start therapy. This means a short written note stating that you have informed your health care provider of your decision to engage in Mental and Emotional Release®.) Furthermore, nothing that happens here in therapy should be construed as, nor should you believe that it is a substitute for the advice of a licensed person.
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2. What to Expect: Your alternative health care practitioner has been trained and certified in
Mental and Emotional Release® at the Master Practitioner level and will be doing this technique
along with Neuro Linguistic Programming (NLP) and Hypnosis. The therapy will probably be different from what you might have expected. In total, we will not spend a lot of time talking about the problem, just gathering information about it. In fact, most of the session(s) are about other things.
It is very important for us to discover the internal thought process of HOW you create the problem. That means that we are looking for your strategy, or how you structure the problem. Because our focus is on structure, that means that, once we discover it, we can move on and focus on having the problem disappear very quickly.
Because of this, your Mental and Emotional Release® Master Practitioner may cut short your answers or even talk about your problem in ways that you have never considered. He may even ask you questions that you do not totally understand consciously in order for your Unconscious Mind to make the changes you want at the unconscious level. It is important to do this so that we can reduce the time taken for the therapeutic process.
If you have been in a therapy session before, expect that this one will be very different, and quite a bit shorter in how long it takes to notice changes and improvements.
In preparation for a Breakthrough Session we will probably assign you some very specific tasks to do. If assigned, these tasks are absolutely a fundamental part of the therapy. They may take up to several days or weeks to complete. The tasks are directly related to setting you up for success and will be discussed during the pre-session. You Must Do Them. If you do not, then neither you nor we can predict the outcome of the therapy. Certainly, any guarantees will not be valid if you do not do the tasking.
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3. This is the Process: We begin with you telling us the problem. We will ask you for examples of the problem and other questions to discover HOW you do it in your head. We will also probe to discover the source of the problem—the precipitating event(s). Some time before the end of this part of the session we will ask you what has to happen so you will know the problem is gone.
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4. After the Session: We will probably assign you some very specific tasks to do. If assigned, these tasks are absolutely a fundamental part of the therapy. They may take up to several days or weeks to complete. The tasks are directly related to the circumstances that created the problem. You Must Do Them. If you do not, then neither you nor we can predict the outcome of the therapy. Certainly, any guarantees will not be valid if you do not do the tasking.
The second thing that is important is that you will need to stubbornly focus on what you want. The people who are the happiest over-all in life are those who recognize that you have a choice to focus on what you don’t want or what you do want. You can focus on negative emotions and things that make you feel bad, or you can focus on positive emotions and things that make you feel good. It is your choice. After the session, You Must Focus On What You Want.
Finally, if your old pattern rears its ugly head, then you must refuse to run that pattern again. Please remember that we have the utmost total and complete respect for you and absolutely no respect for your old problem.
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5. This is Alternative or Complementary Health Care and Therapy: Your Mental and Emotional Release® Master Practitioner is a legal Complementary Healthcare Provider, and not a licensed Medical Doctor, Psychologist, Psychiatrist, Licensed Marriage and Family Therapist (LMFT), Master’s in Family and Child Counseling (MFCC), or a Master’s in Social Work (MSW). The services you receive are not licensed in this state, nor are they regulated by a governmental body. The self-regulated holistic treatments and client-centered disciplines in which your practitioner is trained and in which he/she has experience include, consulting and coaching, Mental and Emotional Release®, Neuro Linguistic Programming (NLP) and Hypnosis. We will always provide only those services in which we have been trained and/or have experience with, and if we find that we cannot help you, we will refer you to a licensed person who can assist you. During your therapy session we will use one or more of the following techniques:
Definitions:
Mental and Emotional Release®: The techniques are a process of active imagination where the client imagines floating above his/her Time Line and letting go of his/her negative emotions and or limiting beliefs. Then the client is also asked to imagine creating events in his/her future that support his/her goals or outcomes. Mental and Emotional Release® has demonstrated results in a broad variety of presenting problems. It is a powerful technique which allows clients to make long-lasting changes in a very rapid way. Your practitioner is certified as a Mental and Emotional Release® Master Practitioner by the Association of Integrative Psychology.
Neuro Linguistic Programming (NLP): NLP is a model of communication—how we communicate to self and others—and how that communication creates and affects our behavior. As a study, it is a synthesis of cognitive and behavioral philosophies which focus on the information coming in through the neurology (cognitive) and the programs we run inside our heads to produce the behaviors (behavioral) we do. Your practitioner is certified as an NLP Master Practitioner by the Association of Integrative Psychology.
Hypnosis: This is the use of trance to make changes at the unconscious level. Hypnosis has been used to produce unconscious change with clients since 1843. All of our practitioners are trained and certified as Hypnotherapists by the Association of Integrative Psychology. Since Hypnosis may be used during your session, for your safety you should make sure that you are totally wide awake before driving or doing any other activity that may require concentration. Your practitioner is certified as a Hypnotherapist by the Association of Integrative Psychology.
Breathwork: Breathwork is a general term used to describe various practices that involve conscious control and manipulation of breathing patterns. These practices aim to influence physical, mental, and emotional states. Breathwork techniques can range from simple, mindful breathing exercises to more structured and intensive practices. Key Components of Breathwork:
Conscious Breathing: Breathwork emphasizes awareness and intentional control of the breath. This can involve deep, slow breathing, rhythmic breathing, or specific patterns designed to achieve particular outcomes.
Variety of Techniques: There are numerous breathwork methods, each with its own techniques and goals. Some of the most well-known include:
Pranayama: Originating from yoga, this practice involves various breathing techniques to regulate energy (prana) in the body.
Holotropic Breathwork: Developed by Stanislav Grof, this method involves fast, deep breathing combined with evocative music to induce altered states of consciousness for therapeutic purposes.
Rebirthing Breathwork: Focuses on circular breathing to release suppressed emotions and past traumas.
Wim Hof Method: Combines specific breathing techniques with cold exposure and meditation to enhance physical and mental resilience.
Meditation: Meditation is a practice where an individual uses a technique – such as mindfulness, focusing the mind on a particular object, thought, or activity – to train attention and awareness, and achieve a mentally clear and emotionally calm and stable state. It is a practice that has been used for thousands of years in various forms across different cultures and spiritual traditions. Key Components of Meditation:
Focused Attention: This involves concentrating on a specific object, breath, sound, visualization, or mantra to anchor the mind and reduce distractions.
Mindfulness: Being present in the moment without judgment, observing thoughts and feelings as they arise and pass without attachment.
Relaxation: Meditation often induces a state of deep relaxation and tranquility, which can reduce stress and promote a sense of well-being.
Altered States of Consciousness: Some forms of meditation aim to transcend normal waking consciousness, achieving a state of deep inner peace or heightened awareness.
Past Life Regression: A therapeutic technique that employs hypnosis to help individuals explore experiences and memories that they perceive as originating from previous lifetimes. The process involves guiding individuals into a deeply relaxed state to access subconscious memories, with the aim of providing insights into current life challenges, understanding behavioral patterns, and promoting emotional healing and personal growth. This technique is practiced within the context of personal belief systems and does not rely on any specific religious or spiritual framework.
Somatic Awareness: Somatic awareness is the practice of consciously paying attention to physical sensations and bodily experiences. It involves tuning into the body's internal signals, such as tension, pain, temperature, and movement, as well as emotional states that are felt physically. This heightened awareness helps individuals to better understand their physical and emotional states, promoting overall well-being, stress reduction, and emotional regulation. Somatic awareness is often used in therapeutic and mindfulness practices to enhance the mind-body connection and support holistic health.
Witness Consciousness: Witness consciousness is the state of being in which an individual observes their thoughts, emotions, and experiences from a detached, impartial perspective. It involves cultivating a sense of awareness that watches the flow of the mind without getting entangled in it, allowing one to observe mental and emotional activities without judgment or attachment. This practice helps to develop mindfulness, enhance self-awareness, and achieve a sense of inner calm and clarity. Witness consciousness is often associated with meditative and contemplative practices aimed at fostering greater insight and understanding of oneself.
Energy Work: Energy work refers to holistic healing practices that aim to balance and enhance the flow of energy within the body. These practices are based on the belief that the body's energetic system influences physical, mental, and emotional well-being. Techniques include Reiki, acupuncture, Qigong, Healing Touch, and crystal healing. The primary goals are to remove energy blockages, promote relaxation, support healing, and enhance overall well-being. Practitioners use hands, visualization, and intention to direct energy, while clients may experience sensations such as warmth, tingling, or deep relaxation. Energy work is used for physical health, emotional healing, spiritual growth, and preventive care.
Cold Plunge: A cold plunge involves immersing the body in cold water, typically at temperatures below 60°F (15°C), for a short period. This practice is used to promote physical and mental health benefits such as reducing inflammation, enhancing recovery, boosting circulation, and improving mood and mental clarity. Cold plunges are often used by athletes, in wellness routines, and as part of holistic health practices to invigorate the body and support overall well-being.
Contrast therapy: Contrast therapy, also known as hot-cold therapy, involves alternating between hot and cold treatments, such as immersing in hot and cold water or using hot and cold compresses. This practice is used to improve circulation, reduce inflammation, alleviate muscle soreness, and promote recovery. By rapidly changing temperatures, contrast therapy stimulates blood flow and helps in the management of pain and swelling, often used by athletes and in therapeutic settings for enhanced physical recovery and overall well-being.
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6. Confidentiality: We keep all information we receive from you, confidential, and do not
disclose it. All client information is kept strictly confidential and is for internal use only. However, there are specific situations where we are legally and ethically obligated to breach confidentiality and report information to the appropriate authorities. These situations include:
Suspected Child Abuse or Neglect: If we suspect that a child (under 18 years old) is being abused or neglected, we must report this to child protective services or law enforcement.
Elder or Dependent Adult Abuse: If we suspect that an elder (aged 65 or older) or a dependent adult is being abused, neglected, or financially exploited, we must report this to adult protective services or law enforcement.
Imminent Risk of Harm: If we believe that you pose an imminent risk of harm to yourself (suicidal behavior) or to others (homicidal behavior), we are obligated to take steps to ensure your safety and the safety of others. This may include contacting law enforcement or a mental health crisis team.
Court Orders: If we receive a court order or subpoena requiring the release of information, we must comply with the legal requirement. We will inform you and seek to handle the situation with the utmost care and confidentiality.
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7. Your Guarantee: All work that we do is guaranteed. That means that you will receive the support and follow-up to ensure that you get the results you wanted. We guarantee our work because our experience has shown us that our clients always get results. The guarantee works like this:
-You must finish the program. That means, attend every session. You must go through the entire process of therapy all the way to the end.
-You must do the tasking after the session, and you need to do it fully and completely.
-Having done this and allowed up to 2 weeks for the process to integrate, then we agree to give you your money back if you have had zero positive changes from the experience.
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8. Your Choice, Your Responsibility: While, during the session, we will offer you advice and other ways of looking at your problem and its solutions for your consideration. You hereby agree that whatever we discuss is only our perspective and is not binding upon you, nor is it a prescription. If you want to discuss our suggestions with someone else, you should discuss them with a licensed health care provider. It is your responsibility to confirm whether or not any changes we made produced the desired results. It is your responsibility to communicate your results to us. Our liability is limited to the amount paid for the therapy.
Terms & Conditions - Part 3
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Ketamine Guidance: Your Coach is not a not a licensed medical professional. The optional guidance and support provided in relation to ketamine therapy, whether administered intravenously (IV) in a clinical setting or sublingually through Mindbloom, are intended solely for educational and supportive purposes. The Coach’s role is to help you navigate your therapeutic journey, offering emotional and informational support based on the understanding of ketamine therapy.
Important Points:
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Medical Advice: The information and guidance provided by your Coach should not be considered medical advice. Clients should always consult with a licensed healthcare provider for medical advice, diagnosis, or treatment.
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Prescription and Administration: Ketamine therapy, whether IV or sublingual, must be prescribed and administered by a licensed medical professional. Clients must follow all medical advice and instructions provided by their prescribing physician or healthcare provider.
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Clinical Setting: For IV ketamine therapy, treatment must be conducted in a licensed medical facility under the supervision of qualified healthcare professionals. Your Coach does not administer or provide medical treatment of any kind.
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Risks and Side Effects: Ketamine therapy can have potential risks and side effects. It is essential for clients to discuss these with their healthcare provider before beginning treatment. Your Coach does not provide medical assessments or monitor side effects.
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Emergency Situations: In the event of a medical emergency or adverse reaction, clients should contact emergency services immediately. They should not rely on the Coach's guidance for urgent medical situations.
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Mindbloom: If clients are using sublingual ketamine therapy through Mindbloom, they should ensure that all treatments are conducted in accordance with Mindbloom's protocols and under the guidance of their licensed medical staff. Your Coach is not affiliated with Mindbloom and does not assume responsibility for their services.
Important Safety Information
Mindbloom pairs individuals with licensed clinicians who are trained to diagnose and treat anxiety, depression, and other mental health conditions. If one of the licensed clinicians, in their medical judgment, decides that ketamine is an appropriate treatment for an individual based on a clinical assessment, then the clinician may prescribe ketamine tablets that are compounded by pharmacies under Section 503A of the federal Food, Drug, and Cosmetic Act (FDCA). Drugs compounded under Section 503A do not require FDA approval, and as such the FDA has not determined that the compounded ketamine prescribed is safe and effective for anxiety, depression, or other mental health conditions. The use of ketamine for anxiety, depression, and many other mental health conditions, however, is supported by a body of scientific literature.
Ketamine is a Schedule III controlled substance. Other drugs containing ketamine, which (unlike compounded drugs) are subject to FDA’s approval requirements, have been FDA-approved as an intravenous or intramuscular injection solution for induction and maintenance of general anesthesia. However, those drugs have not been FDA-approved for anxiety, depression, or other mental health conditions, and they have not been FDA-approved in tablet form. The approved label is available here.
Ketamine may cause serious side effects, including but not limited to risks of: sedation; dissociation; psychiatric events or worsening of psychiatric disorders, including problems in people with schizophrenia, severe personality disorders, or other serious mental disorders; dependence, abuse and misuse; anxiety; increases in blood pressure or heart rate; respiratory depression (breathing becomes slower and shallower and the lungs fail to exchange carbon dioxide and oxygen efficiently); lower urinary tract and bladder symptoms, including frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size; altered sense of time; dry mouth; elevated intraocular or intracranial pressure; loss of appetite; confusion; nausea/vomiting; blurred vision; and slurred speech.
The FDA has advised that at-home administration of compounded ketamine may present additional risks because a health care provider is not available onsite to monitor for adverse outcomes resulting from sedation and dissociation.
Mindbloom’s protocols and guidance have been designed to minimize the likelihood of experiencing these side effects or other adverse effects, and should be followed carefully. Ketamine should only be taken as directed by the treating clinician.
Do not proceed with ketamine treatment if any of the following apply to you:
Allergic to ketamine
Symptoms of psychosis or mania
Uncontrolled high blood pressure
CHF or other serious heart problem
Severe breathing problem
History of elevated intraocular or intracranial pressure
History of hyperthyroidism
Other serious medical illness
Pregnant, nursing, or trying to become pregnant
Ketamine has been found to cause moderate psychological dependency in some users.
In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size
Ketamine may worsen problems in people with schizophrenia, severe personality disorders, or other serious mental disorders
Users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your clinician before proceeding with treatment
The dissociative effects of ketamine may increase patient vulnerability and the risk of accidents
To promote positive outcomes and ensure safety, follow these ketamine treatment guidelines:
Do not operate a vehicle (e.g., car, motorcycle, bicycle) or heavy machinery following treatment until you’ve had a full night of sleep
Refrain from taking benzodiazepines or stimulants for 24 hours prior to treatment
Continue to take antihypertensive medication as prescribed
Do not take ketamine while hungover or with alcoholic beverages
Refrain from consuming solid foods within 3 hours prior to treatment and liquids within 1 hour prior to treatment
Ketamine treatment should never be conducted without a peer treatment monitor physically present
A peer-reviewed study of Mindbloom’s client treatment outcomes was published in the Journal of Affective Disorders in 2022, titled At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial. The FDA has not evaluated head-to-head trials comparing the safety of ketamine to other medications that are FDA-approved for the treatment of depression, anxiety, or other psychiatric disorders. Although some clients report that they had more success with ketamine than with FDA-approved therapies, these outcomes may not be typical.
For more information about the informed consent that clients review and sign prior to treatment, please visit mindbloom.com/informed-consent.
By engaging in ketamine therapy, clients acknowledge and agree that your Coach's role is limited to non-medical support and guidance. Clients agree to follow all medical instructions provided by their licensed healthcare providers and assume full responsibility for their health and well-being.
If clients have any questions or concerns about their ketamine therapy, they should consult with their prescribing physician or healthcare provider.