Emotion Code Consent Form
1. I understand that The Emotion Code, as taught by Dr. Bradley Nelson, (hereinafter called “this method”), and as practiced by the practitioner listed below, seeks to identify and eliminate underlying imbalances by releasing energetic imbalances in emotions. This method of energy healing promotes harmony and balance within, relieving stress and supporting the body’s natural ability to heal. Energy healing such as this method 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 imbalances using this method as practiced by the practitioner listed below 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 this method is not a replacement for any professional psychotherapeutic or counseling sessions in the treatment of any mental health issues or disorders, 3. I understand that if my practitioner makes any suggestion regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, or any compounds or any 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 emotions may result in “processing”, where echoes of the emotions 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 claim 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. I agree that my practitioner will not be held liable for any health/medical issues, problems, conditions, diagnosis, or results, and that I am solely responsible for my life and decisions. 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, 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.healerslibrary.com and/or reading his book The Emotion Code. 9. I understand that by checking the box, “I accept,” I fully consent to participating in Emotion Code sessions with the practitioner listed below.