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Nested Hearth LLC · Surprise, Arizona
Consent Form

Client Agreement

Please read through before your first session — then sign at the bottom

This agreement exists to make sure you know what to expect from me, what I'm able to offer, and what falls outside my scope. None of this is meant to feel clinical or intimidating. It's a clear foundation so we can do the work well together.

Your information
Understanding the work

Biodynamic Craniosacral Therapy (BCST) is a gentle, non-invasive modality that supports the body's own capacity for self-regulation. It is not a medical treatment. It does not diagnose, treat, or cure any condition or disease. It is not a substitute for medical care.

Health Coaching is a supportive, client-led conversation focused on general wellness. It is not therapy, counseling, psychotherapy, or medical advice. I do not diagnose, treat, or prescribe anything.

I am a certified Biodynamic Craniosacral Therapist (BCST) through Body Intelligence Training, and a certified Health Coach through mindbodygreen, an NBHWC-approved training program. I am not a licensed medical provider, therapist, or mental health professional. If something arises that falls outside my scope, I will always refer you to the appropriate professional.

Confidentiality

Everything you share with me is held in complete confidence. I do not share your information or session content with anyone — with the following legal exceptions:

Mandatory reporting: Under Arizona law, I am required to report reasonable suspicion of abuse, neglect, or non-accidental injury involving a minor or vulnerable adult to the appropriate authorities. (A.R.S. §13-3620; A.R.S. §46-454)

Imminent danger: If I have reasonable belief that you or another person is in imminent danger of serious harm, I may contact emergency services.

Outside of these situations, nothing you share leaves this space without your written permission.

Crisis protocol

My work is supportive — it is not crisis intervention. If you share that you are experiencing active thoughts of suicide, self-harm, or intent to harm another person, I will provide crisis resources and strongly encourage you to contact a licensed mental health professional or emergency services immediately.

For coaching clients: If you are in an active mental health crisis, I will ask that you be working concurrently with a licensed mental health provider before we continue sessions. This is how I make sure you are held well at every level.

Your records

I maintain basic session records securely and privately for a period of six years. I do not share your records with any third party without your written consent, except as required by law. This practice is not subject to HIPAA, as Nested Hearth LLC is not a covered healthcare entity.

Location & jurisdiction

Sessions are offered in person in Surprise, Arizona and remotely via phone or video. Clients may be located anywhere in the world. My services are general wellness support only and are not jurisdiction-specific medical or therapeutic advice. This agreement is governed by the laws of the State of Arizona. Clients located outside Arizona are responsible for understanding any regulations applicable to wellness services in their own location.

Cancellation policy

Payment is due at the time of service.

48 hours or more noticeNo charge
24 to 48 hours noticeHalf the session fee
Less than 24 hours noticeFull session fee
Referrals

I may recommend that you work with another provider if something arises that falls outside my scope. This is always in your best interest and never a reflection of our work together.

Testimonials

I will always ask for your written consent before using any testimonial or feedback. I will never use identifying photos of individual clients. You may withdraw consent at any time.

Your agreement

Please check each item:

Signature

Signature — write or type your full name.

When you send this, your completed agreement travels straight to me by email — nothing is stored on this page or shared anywhere else.

Email app didn't open?

Copy your responses below and paste them into an email to jenn@nestedhearth.com.

Signed and sent.

Your email should have opened with your completed agreement ready to send — just press send and it comes straight to me. If it didn't open, you can reopen the form and copy your responses instead.

Thank you. This clears the way for us to do the work well together.