THE EMOTION CODE + THE BODY CODE SYSTEM
Consent Form as of 5/15/2019
1. I understand that The Emotion Code, as well as the Body Code System, as taught by Dr. Bradley Nelson, (hereinafter called these "methods”), and as practiced by the practitioner listed below, seek to identify and eliminate underlying imbalances by releasing energetic imbalances in the areas of energy, circuitry, pathogens, structure, toxicity, and nutrition. These methods of energy healing promote harmony and balance within, relieving stress and supporting the bodies natural ability to heal. Energy healing such as these methods 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 imbalance using these methods as practiced by the certified practitioner, 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 these methods are not a replacement for any professional psycho-therapeutic or counseling sessions in the treatment of any mental health issues or disorders.
3. I understand that if my practitioner makes any suggestions regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, or any compounds or any other 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 emotion(s) or other energy(s) may result in ”processing,” where echoes of the emotion(s) or other energy(s) 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 claims 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.
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, subject to any exceptions governed by laws of the
State of residence of my practitioner listed below, or of Federal laws and regulations, and that identifying
personal information such as my last name and city will be deleted to maintain my privacy, unless required by
8. I understand that I am advised to be self-informed about this work by visiting Dr. Bradley Nelson’s website.
and/or by reading his book The Emotion Code.
9. I understand that by signing and submitting this form, I fully consent to participating in Emotion Code and/or Body Code session(s) with Certified Emotion Code Practitioner Katy Joyner as fully outlined herein. I understand that this consent agreement will remain on file with Full Cup Wellness Co. unless I email and ask for services to be cancelled and consent to be removed.
24 hours notice is required for any appointments to be rescheduled. Refunds are not available.