:: Create Emotional Checklist 2.0

Please choose a score of 1-10 after each question

1 to 10 Scale
Login or Register as a New User
You are not currently logged in. In order to post this item please login now or provide the following details to register.

 

Free Emotional Checklist Evaluation
•    Request an SR® Counselor after you register for a Free Emotional Checklist Evaluation & Recommendations
•    SR® Introduction, Step 1 and Step 7 audio along with the exclusive SR® Progress Tracker will be made available to you immediately after registration
•    After approval from an SR® Counselor the remaining steps of the SR® process will be made available to you.

Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Please choose a password for your account; it must be at least 6 characters.
Basic Information
Format: May 17, 2012
Counselor Information

This is an optional field and will only be visible to whoever you choose to be your counselor.

Briefly describe the improvements you'd like to make through the SR® process and a counselor. Please keep in mind, SR® does NOT require background information, this is simply for describing the improvements you would like to make. For example "I'd like to improve my eating habits," or "Improve my emotional state."

Contact
This field is optional. If you would like your counselors to have this information, put your preferred phone number here. Be sure to include the area code.
Terms of Use

CSRC - Client Agreement

CSRC and Client Definition – The term CSRC refers to the Certified Subconscious Restructuring® Life Coach/Counselor and the term Client refers to the person requesting services from the CSRC.

SR® Definition - Subconscious Restructuring® or SR® is the process of learning how the subconscious works for the purpose of taking control of one's emotional state and behavior via Restructuring of Subconscious processes.

I fully understand Subconscious Restructuring® is a Program Process and is NOT psychotherapy. SR® is a set of tools that will empower me to recognize access and change subconscious programming that simply does not work. Through the course of this program process no background information is needed. Should I volunteer information to assist in the progression of the program it will be held in the strictest of confidence unless otherwise compelled by law.

The Emotional Checklist – The Emotional Checklist is the only information the CSRC requires in order to monitor my progress. The Client has the right to retain The Emotional Checklist with the clear understanding the CSRC will only have a verbal means of monitoring the Client’s progress and will not have any information to base a guarantee of the results produced.

CSRC Obligations – The CSRC is NOT required to refer the client to a third party based on any information from the Emotional Checklist or voluntary information revealed to the CSRC by the Client. Should the Client deem it necessary to see a physician, psychologist or psychiatrist this decision will be entirely up to the Client.

Clients Rights – The Client waives any right to legal action against the CSRC should the Client be dissatisfied with the information presented or for any other reason in regard to the program process of SR®.

CSRC, Subconscious Restructuring® Institute Relationship – Each CSRC are independent of the company of the Subconscious Restructuring® Institute unless stated otherwise.

Copyright and Trademarks – All materials provided are the copyright of the Subconscious Restructuring® Institute and Subconscious Restructuring® is a registered trademark.

Client Data - The SR® Institute and every CSRC will respect the confidentiality of the client's information, except as otherwise authorized by the client, or as required by law. Whenever data is compiled for statistical purposes all personal information will be removed. The SR® Institute and all CSRC’s will obtain an agreement from the client before releasing their name’s as clients or references, or any other client identifying information. Should the clients data be compromised by means not within the control of the SR® Institute the client agrees the SR® Institute cannot be held liable.

I am age 18 or over

Burris Institute | ©1990 - 2012