I understand that the Emotional Release Therapy techniques known as Emotion Code and Body Code (hereinafter called “these methods”), as taught by Dr. Bradley Nelson, and as practiced by the practitioner Mallory Paige CECP CBCP (hereinafter referred to as “Practitioner”), 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 body’s natural ability to heal. Energy healing such as these methods is widely recognized as a valuable and effective complement to conventional medical care.

I understand that releasing trapped emotions, or the correction of any other energetic imbalance using these methods as practiced by the 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.

I understand these methods are a gentle, complementary energy-based approach to health and healing that may be accomplished through the use of light physical contact to the back or head (Governing Meridian) with a hand or magnet. I give consent and permission to Practitioner to conduct these methods to balance my energy system, knowing it may include light touch and / or stroking or touch at various points on my body. I have been made aware that I may decline any physical contact, change my consent to physical contact at any time, or leave. I also understand that should I choose not to have any physical contact, I have the option to give consent for Practitioner to act as “proxy” for me so that I may still enjoy the benefits of a session.

I understand that if 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 Practitioner.

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. I understand that most people process the energy released very easily with no discomfort, however, occasionally, there may be some symptoms that come along with “processing,” such as emotional irritability, fatigue, headache or nausea. I understand that my personal results following each session depend on what emotions released from my body, my stress level and other external factors in my day-to-day life. I understand that I am to contact Practitioner immediately if any processing work is too uncomfortable so that she may help me.

I understand that 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.

I understand that if I have health concerns, I am recommended to seek advice from an appropriate medical provider 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.

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 Practitioner, 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 law.

I understand that I am advised to be self-informed about these methods by visiting Dr. Bradley Nelson's website: www.discoverhealing.com or by reading his book The Emotion Code.

Except in the case of gross negligence or malpractice, I and my representative agrees to fully release and hold harmless Practitioner Mallory Paige, Wellness Maven, for and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session. My questions have been answered to my satisfaction regarding Practitioner’s background.

I understand that by filling in the intake form, I fully consent to participating in Emotional Release Therapy session(s) with Practitioner.