for the practice of Jenifer H. McCarthy, CECP of Return To Me, LLC

Thank you for choosing to allow me to assist you in your energy healing journey. I am a Certified Emotion Code© Practitioner (CECP) and I am passionate about helping people. I also respect the needs and rights of my clients. As part of the energy healing process it is essential to inform you of the nature of The Emotion Code© energy work. The following information and disclaimers are required to safely and effectively practice my energy work with you. Please read carefully and sign to provide your consent and begin our journey together.

The following references will be used for the remainder of the document: The Client (herein referred to as “I”, “you”, or “my”), The Emotion Code©, as taught by Dr. Bradley Nelson, (herein referred to as the “method” or “methods”), Jenifer H. McCarthy, CECP of Return to Me, LLC (herein referred to as “the practitioner” or “my practitioner”), and Return to Me, LLC (herein referred to as “us”, “we”, or “our”)

INFORMED CONSENT

1. I understand that The Emotion Code©, as taught by Dr. Bradley Nelson, and as practiced by Jenifer H. McCarthy, CECP of Return to Me, LLC, seeks to identify and eliminate, by energetically releasing, underlying imbalances in the areas of energy. These methods of energy healing promote harmony and balance within, relieving stress and supporting the bodyʼs natural ability to heal. Energy healing such as these methods is widely recognized as a valuable and effective complement to conventional medical care.

2. I understand that releasing trapped emotions, or the correction of any other energetic imbalance using these methods as practiced by the practitioner, is not a substitute for medical care. This information is not intended as medical advice and should not be used for medical diagnosis or treatment. Information received is not intended to create any physician-patient relationship, nor should it be considered a replacement for consultation with a healthcare provider, nor is it meant to replace any medical treatments as ordered by any physicians nor any other medical care you have been advised to seek by them. I further understand that these methods are not a replacement for any professional psycho-therapeutic or counseling sessions in the treatment of any mental health issues or disorders.

3. I understand that if my practitioner shares her knowledge of, or makes any suggestions regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, or any compounds or any other external remedy of any kind, that I use or ingest any such at my own risk, with the recommendation that I seek the advice of a physician before using any remedy suggested by my practitioner.

4. I understand that in approximately 20% of sessions, the release of trapped emotion(s) may result in “processing,” where echoes of the emotion(s) released may manifest in temporary physical or emotional discomfort, and that this “processing” appears to be a normal part of regaining energetic balance.

5. I understand that my practitioner makes no claims as to healing or recovery from any illness I may have now, nor the prevention of any illness I may have in the future, and that no guarantee is made towards validity. I further understand that the use of any information I receive is at my own risk.

6. I understand that if I have health concerns, I am recommended to seek advice from an appropriate medical practitioner before making any decisions about my health, and that this information is offered as a service and is not meant to replace any medical treatment.

7. I understand that these sessions are confidential, and that any personal information would be used anonymously for educational and research purposes only, subject to any exceptions governed by laws of the State of residence of my practitioner, or of Federal laws and regulations, and that identifying personal information such as my last name and city will be deleted to maintain my privacy, unless required by law.

8. I understand that I am advised to be self-informed about this work by visiting Dr. Bradley Nelson's website: www.discoverhealing.com and/or by reading his book The Emotion Code©.

9. I understand that by signing this form, I fully consent to participating in The Emotion Code© session(s) with the practitioner.

10. Additional references and materials are available at www.myreturntome.com for further education and contact information.

LEGAL DISCLAIMER

1. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Jenifer H. McCarthy, CECP and Return to Me, LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

2. Jenifer H. McCarthy, CECP, and Return to Me, LLC are not responsible for the failures in security or breach of data resulting from any third-party products (where products cover all services, tools, applications (apps), websites, or communications that are made available by the third-party). All terms and conditions for the use of any third-party product are between the client and the third-party.

3. Any information provided by Jenifer H. McCarthy, CECP, Return to Me, LLC, their communications, and their website is not a substitute for direct, individual medical or psychological treatment or advice. Nor do they make any medical diagnoses, treatments, or cures; nor are they intended to substitute professional medical advice. Always seek your physician's advice or another qualified healthcare provider if you have a medical condition or any questions regarding any medical symptom(s). Do not wait, if you have a medical emergency, please call your doctor or emergency services immediately.

4. All materials are copyrighted by Return to Me, LLC except where noted.

POLICIES

1. Cancellation Policy: Please notify us at least 24 hours in prior to your scheduled appointment. Any cancellation or no-show with less than 24 hours notice is subject to a cancellation fee equal to the cost of the scheduled service. If cancelling a session from a previously purchased package, within 24 hours, that session will be deducted from that package.

2. Refund Policy: A full refund will be issued back to original form of payment (including gift cards) for appointments that are cancelled at least 24 hours in advance or more. No refunds for completed sessions. No refunds for packages after 6 months of purchase. Refunds for package sessions purchased within 6 months will be issued at the discounted package value per session. No refunds for gift cards after 3 months. Refunds for gift cards purchased within 3 months will be issued only for their remaining value.

3. Minor Policy: For all children under the age of 18, the parent or guardian must be present, although the child does not have to be present, on the phone or video call for the entire duration of the session. If the parent or guardian is not able to be present the session will be canceled. All communications outside of a session will only be with the parent or guardian. If there’s attempted communication by a minor outside of a session, the parent or guardian will be notified.

4. Pet/Animal Policy: We love pets and animals but we are not responsible for their behavior, before, during, or after a session. The owner must be present, although the pet/animal does not have to be present, on the phone or video call for the entire duration of the session. If the owner is not able to be present the session will be canceled.

5. Practitioner Rights: We deeply care about your health, wellbeing, and the success of your energetic journey. While we strive to provide the best service that we can, the practitioner reserves the right to cancel an appointment for any reason at any time. In some cases this may mean that there are circumstances that we can not help with due to the need for the intervention of a medical, psychological, or other health professional. We may make recommendations for other practitioners that are a better match or are able to support you with different modalities. In the event that we feel that there is a medical or psychological issue that requires the attention of a professional we will indicate this to you and reserve the right to cancel the session.

6. Privacy Policy: We value you as a client. You will always be treated with the upmost respect and integrity. Confidentiality is a very important principle to this practice and we will actively protect the personally identifiable information (PII) that you provide to us from unauthorized disclosure. This means that any PII that you provide will be safeguarded using reasonable methods by the practitioner. Standard and commercially available and acceptable forms of communication such as third party tools for emailing, messaging, texting, phone (voice/audio) calls, video (audiovisual) calls, voicemails, and recordings (audio or audiovisual) are subject to the protections referred to above, in that the information provided by the client will be only for the support of the practitioner/client professional relationship. No PII will be willingly disclosed except with the written permission of the client or as subject to any exceptions governed by laws of the State of residence of my practitioner, or of Federal laws and regulations. The client is responsible for the data, the amount of data, and level of data provided in communications to the practitioner using third-party products and is subject to their privacy policies.

REFERENCES

1. Copyright © 2007-2023 Wellness Unmasked, Inc. and Dr. Bradley Nelson (The Emotion Code©, Informed Consent, Sections 1-9)
2. Copyright © 2009-2023 by Energy Medicine Professional Association (Legal Disclaimer, Section 1)
3. Copyright © 2023 Return to Me, LLC and Jenifer McCarthy (Form Name: RTMLLC_Consent_Form_Rev001, Date: 09/01/2023)