Consent to Treat

Consent to Treat

Consent to Treat, Scheduling Policy & Discontinuation of Services

Hearth Science, Inc. — The Autonomics Clinic

This agreement is between you and Hearth Science, Inc. It outlines the nature of our work, what you can expect from sessions, our scheduling terms, and the conditions under which treatment may end. Please read it in full before your first session.

1. What Is Hearth Science?

Hearth Science, Inc. works at the intersection of neuroscience and mindful awareness. This is an emerging field and modality, developed over roughly 15 years with nearly 150 mentors across 25 disciplines of wellbeing in 24 cultures, crowdsourced from 5,000 wellness professionals, and field-tested with over 15,000 people in 50 countries. Hearth Science's work is not currently a regulated industry in California. Our work has been featured in Psychology Today, Psychotherapy Networker, and other publications, and our Founder, Gabriel Kram, has presented internationally in medical, mental health, leadership, government, non-profit, and corporate settings.

We work non-invasively, in real time, with your Autonomic Nervous System (ANS) — the neural architecture of your mindbody connection. Individual sessions address dysregulations of autonomic physiology, which commonly present as stress-related conditions: anxiety, depression, gastrointestinal distress, sleep difficulty, traumatic stress injuries, and developmental trauma. We also work with clients seeking to expand their capacity for regulation and co-regulation under demanding conditions, including elite performance contexts.

2. What Is Healing and Transformation?

Healing and transformation are non-linear processes — baseline shifts in the complex adaptive system that is you. A healing journey tends to resemble a spiral more than a line, and periods that feel like regression relative to where you began are part of the process, not a sign that something has gone wrong. Integration of new ways of sensing, feeling, and being takes time, particularly when addressing conditions that formed over long durations.

The ANS has three primary states, depending on whether you feel safe, in danger, or under life threat in the present moment. When you feel safe at an embodied level, the ANS can surface the connection system — the neurobiological foundation of wellbeing. When you do not feel safe, the ANS surfaces defensive platforms, which may include fight, flight, or various forms of shutdown, arising individually or in combination. Our work focuses on state-specific intervention: helping you identify your states with precision, understand the context in which they arise, and develop practices that address them in the moment and shift the baselines that give rise to them over time.

Hearth Science is founded on the premise that you are a sovereign being, ultimately responsible for shepherding your own healing process. No one can do this to you or for you — we can witness and accompany you.

3. A Relational Modality

This work is expressed through your relationship with yourself, with your facilitators and practitioners, and with the more-than-human world. Our interventions are outcome-oriented: to help restore functionality and shift your baseline from distress toward wellbeing. Your facilitator will meet with you initially to form a diagnosis and prepare a treatment or coaching plan, which you can help shape to your own cadence and preferences. Sessions may be in person or remote; some referrals within our network require a locally affiliated practitioner, and some clients travel to our eco-reserve in Northern California for intensives.

4. What Hearth Science Is Not

Hearth Science is not medicine, functional medicine, integrative medicine, psychotherapy, or counseling — though a facilitator may also hold credentials in these fields, and referrals within our network may include them. Hearth Science does not address mental disorders as defined by the American Psychiatric Association. Your sessions are not a substitute for counseling, psychotherapy, mental health care, physical health care, or substance abuse treatment, and are adjunct to, not a replacement for, such care. Unless your facilitator is a licensed medical or mental health practitioner, they are not making medical or mental health recommendations.

5. Clinical Scope and Fit

Hearth Science assumes the basic mental health of the client. If you are dealing with active psychosis, or an active Axis I diagnosis (e.g., Major Depression, Generalized Anxiety) or Axis II diagnosis (personality disorder), this is not the correct modality for you. Our objective is to support you toward resolution of your presenting distress as efficiently as is appropriate for you; the duration and cadence of treatment vary by individual.

6. During Sessions

Your facilitator may invite you into awareness practices, movement, or shared narrative — bringing attention to a thought, emotion, or bodily sensation, shifting attention across sensory modalities, adjusting posture, or working with your breath — generally while tracking your ANS.

7. Risks

Working directly with the ANS carries a risk that symptoms may intensify before they ease. You may experience emotional discomfort, or bodily sensations, vibrations, or temperature changes that are uncomfortable, including increases in pain as symptoms shift out of shutdown responses into distress responses with heightened interoceptive awareness.

8. Data, Confidentiality, and Consent

Our learning platform (which may be used as adjunct to your treatment) is HIPAA-compliant and bi-directionally encrypted. Information you share that may constitute Protected Health Information (PHI) may be retained on our servers during treatment and shared with the practitioners comprising your care team. You may request removal of this data at the conclusion of treatment. You consent to de-identified use of your data to improve our interventions, and to your care team's review of your engagement data to monitor progress toward treatment goals.

Sessions remain confidential except: when we consult colleagues, mentors, or advisors to better support you (with your permission); when we refer you within our network and sharing case notes would help (with your permission); when you express intent to harm yourself or others; or when you ask us to share information with a person of your choosing.

9. Client Rights

You have the right to discontinue treatment at any time. Section 13 (Discontinuation of Services) describes how this right is exercised and how fees are handled when it is.

10. Acknowledgment of Understanding

I acknowledge that I have read, understand, and consent to Hearth Science individual treatment sessions. I am aware of the risks involved, including risks of which I may not presently be aware, and I agree to comply with applicable laws, policies, and my facilitator's instructions. I understand that Hearth Science, Inc. does not insure participants and bears no responsibility or liability for injury resulting from this activity. I voluntarily elect to participate with knowledge of the risks involved, and I accept and assume those risks.

11. Waiver of Liability and Indemnification

In consideration for being allowed to voluntarily participate in the above-referenced activity, on behalf of myself, my personal representatives, heirs, next of kin, successors and assigns, I forever:

• waive, release, and discharge Hearth Science, Inc. & Natureza LLC, and its agencies, officers, and employees from any and all negligence and liability for my death, disability, personal injury, or claims of any nature which may hereafter accrue to me and my estate as a direct or indirect result of my participation in this activity; and

• agree to defend, indemnify, and hold harmless Hearth Science, Inc. & Natureza LLC, its agencies, officers and employees, from and against any and all claims of any nature, including all costs, expenses, and attorneys' fees, which in any manner result from my actions during this activity.

This release, indemnification, and waiver shall be construed broadly to the maximum extent permissible under applicable law. I affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and understand that by signing it I am giving up legal rights and remedies otherwise available to me regarding losses I may sustain from my participation. I agree that if any portion of this agreement is held invalid, the remainder continues in full legal force and effect.

12. Scheduling Policy

Hearth Science, Inc. bills for services at the time they are scheduled, at an agreed-upon hourly rate, based on the reserved session length. Because the timing of sessions is dictated by the nervous system's own cycle rather than the clock, an individual session may run shorter or longer than the reserved time. Following each session, we true up the charge to reflect actual time utilized: additional time is billed, and unused time is credited, before your next session is scheduled.

The Autonomics Clinic schedules one clinical session per day. A reserved session holds that day's capacity exclusively for you.

More than 7 days' notice

Sessions may be rescheduled at no cost.

48 hours to 7 days' notice

Sessions may be rescheduled. Fifty percent of the session fee is forfeited and applied as a rebooking charge.

Less than 48 hours' notice, or a missed session

The full session fee is forfeited. The session is not rescheduled without a new booking.

This policy reflects the structure of the practice, not a judgment of individual circumstances. Because only one session is held per day, a late change cannot be absorbed elsewhere in the schedule.

13. Discontinuation of Services

Clinic-Initiated Discontinuation

The Autonomics Clinic reserves the right to discontinue an engagement at any point if a client's presentation falls outside the clinic's stated clinical scope (see Section 5), as determined during the course of treatment. In such cases, fees for sessions not yet delivered will be refunded.

Client-Initiated Discontinuation

Consistent with your right under Section 9 to discontinue treatment at any time, you may end treatment by providing at least seven days' notice. Sessions not yet delivered will be refunded.

14. Acknowledgment

By signing below, I confirm that I have read and understood this Consent to Treat, Scheduling Policy, and Discontinuation of Services, and I agree to its terms.

Signed by, Hearth Science, Inc.