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Survey Consent

This is optional but it will help us measure success.

Congratulations on taking this important step toward a healthy relationship future! We are committed to seeing you succeed, and you'll find everything you need on the following pages. You'll start with Week 1, and week by week, we'll build the skills you need to improve not just romantic relationships but skills you can use in all relationships with everyone you meet. We'll also help you track your progress. Your next step is to create a profile of your current habits by answering a quick series of questions. This will take you about five minutes. You'll fill out the same questionnaires at the end of the program, plus a couple of follow-ups. This will encourage you by showing you just how far you've come, as well as helping gather data to help other people like you. Please read the Research Informed Consent form below, complete your questionnaires, and you'll then be automatically directed to the basic Quick Start program materials. - Dawson Church

Informed Consent to Participate in a Research Study: The Effects of EFT on relationships

- Dawson Church, Ph.D., Principal Investigator


You are invited to participate in a research study. Research studies are designed to gain scientific knowledge that may help other people in the future. You may or may not receive any benefit from being part of the study.

Why is This Study Being Conducted?

The purpose of this study is to compare psychological symptoms & pain after EFT (Emotional Freedom Techniques).

What is Involved in This Research Study?

You will fill out a brief form called the Hospital Anxiety and Depression Survey, which has been used in many other research studies, as well as indicating your level of pain. You will complete again after using the EFT for First Aid program, and again 3 months later.

The Benefits and Risks of the Study?

The possible benefits of participating in this study are improvements in your relationships. To date, research confirms that there are no known side effects to EFT. There is no guarantee that any of your current relationships will be improved by participation in this study. Recalling emotional memories can result in emotional or physical sensations of discomfort.

What About Confidentiality?

Your records are processed anonymously, and by law, researchers who process the study records are required to keep them completely confidential. If the researchers publish the information learned from this study, you will not be identified by name or in any other way.

Who Is Sponsoring This Study?

This study is being sponsored by Soul Medicine Institute, a 501 (c) (3) public benefit nonprofit research and teaching organization (www.SoulMedicineInstitute.org). The sponsor is providing money or other support to help conduct this study. The statisticians analyzing the data do not hold any direct financial interest in the techniques being studied. You agree to take part in this study and confirm that you are 18 years of age or older. If you have any questions about the study, you can contact Soul Medicine Institute at 707 237 6951 or deb@soulmedicine.net. You have had a chance to ask questions about being in this study and have had those questions answered to your satisfaction. By agreeing with this consent form you are not giving up any legal rights to which you are entitled.