The Emotion Code - The Body Code System Consent Form
1. I understand that The Emotion Code and The Body Code Systems, as taught by Dr. Bradley Nelson, (hereinafter called “these methods”), and as practiced by Marcia Canestrano (“the practitioner”) of Shakti Soul Coach, seeks 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 can promote harmony and balance within, relieving stress and supporting the body’s natural ability to heal. Energy healing systems, such as these methods, are 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 these methods as practiced by Marcia Canestrano of Shakti Soul Coach, 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 and any suggestions made regarding grounding techniques, releasing energy or meditations, are 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 Marcia Canestrano of Shakti Soul Coach makes any suggestion regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, any compounds or 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(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. Processing symptoms can include, but are not limited to, fatigue, emotional irritability, trouble sleeping, headaches, and nausea.
5.I understand that Marcia Canestrano of Shakti Soul Coach 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.
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 Florida (the residence of Marcia Canestrano of Shakti Soul Coach), or of the 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.
8. I understand that I am advised to be self-informed about this work by visiting Dr. Bradley Nelson’s website:https:// discoverhealing.com/ and/or reading his books The Emotion Code and The Body Code.
9. I understand that by signing this form, I fully consent for myself and/or my child and/or pet, to participate in Emotion Code and/or Body Code session(s) with Marcia Canestrano of Shakti Soul Coach.
10. I understand that if I am signing for my child under 18, I will help them process through their sessions by encouraging them to stay hydrated, getting outside, and being patient with their feelings
11. Except in the case of gross negligence or malpractice, I agree to fully release and hold harmless Marcia Canestrano of Shakti Soul Coach, from and against any and all claims or liability of whatsoever kind of nature arising out of or in connection with my session(s).
12. I understand that when paying for services, I fully consent to the services offered by Marcia Canestrano of Shakti Soul Coach and all terms stated herein. 13.
13. I agree to allow Marcia Canestrano of Shakti Soul Coach to send me information via e-mail or other communication channels. I understand that my email address, and any other contact information, will be kept confidential and will not be given to any other party.
14. I agree to the above terms and conditions and understand that by agreeing to this form, I fully consent to participating in Emotion Code and/or Body Code session(s) with Marcia Canestrano of Shakti Soul Coach.
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