The Emotion Code/Body Code Consent Form

Please review this consent form prior to our first session.

The Emotion Code/Body Code

Consent Form

I understand that The Emotion Code/Body Code as taught by Dr. Bradley Nelson and as practiced by John Ziehr, seek to identify and eliminate underlying imbalances by releasing energetic imbalances. This methods of energy healing promotes harmony and balance within, relieving stress and supporting the bodyʼs 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 any counseling I receive John Ziehr will be pastoral counseling. John Ziehr will be using the tools God has given to provide the answers to the problems I am experiencing and to help me assume responsibility in finding freedom. I am aware that the John Ziehr not trained professional in psychiatry or medicine.

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

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 John Ziehr 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 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.

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 John Ziehr 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 law.

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 by reading his book The Emotion Code.

I understand that by agreeing to and submitting this form, I fully consent to participating in Emotion Code/Body Code session(s) with John Ziehr.

Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless John Ziehr from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).