A Place for Healing, LLC
Body Code, Emotion Code, Reiki
2022 Consent Form
I understand that the modalities of Emotion Code, Body Code, Reiki, and any other intuitive modalities are energetic healing modalities and do not constitute medical practice.
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 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 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 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 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.
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 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.
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 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 law.
I understand that I am advised to be self-informed about this work by visiting Dr. Bradley Nelson’s website: www.discoverhealing.com and/or by reading his book The Emotion Code.
I understand that by signing this form, I fully consent to participating in Reiki, Emotion Code, and/or Body Code session(s) with the practitioner listed below. If I have a child under the age of 18 for which I request services, this consent applies to such child(ren).
Any dispute, controversy, or claim arising out of or relating to this Agreement, or the breach thereof, or the treatment or services intimated herein shall be settled by binding arbitration in accordance with the commercial arbitration rules of the American Arbitration Association (“AAA”). The arbitration proceedings shall be conducted in Harris County, Texas. The parties shall mutually agree on an arbitrator. If the parties are not able to mutually agree on a single arbitrator, each party will then select an arbitrator, who working together, will appoint a third arbitrator who will serve as the sole arbiter of the dispute. The prevailing party may enter any judgment or award rendered by the arbitration in any court having jurisdiction thereof.
A Place for Healing, LLC. Fee Schedule-2022
Clients see the most effective results after participating in multiple sessions. A new client will purchase a block of three sessions minimum, and may purchase single sessions, or another block of sessions, upon completion.
New Client-Block of 3 Sessions: $200*
· (3) 45-minute sessions to be conducted remotely via phone, Zoom, or email
· Will utilize whichever modality or combination of modalities is most appropriate according to client goals/issues
· To be paid in full before scheduling first appointment
· Must be used within three months of purchase date
· After the initial three sessions, client may purchase single sessions at a rate of $75 per
· All three sessions to be completed by same person-cannot split sessions
· A detailed report of notes will be electronically delivered to client after each session
· *This is a one-time offer for new clients only; multiple offers can be purchased, but must all be used by the same client.
Existing Client-Single Session: $75
· (1) 45 minute session to be conducted remotely via phone, Zoom, or email
· Will utilize whichever modality or combination of modalities is most appropriate according to client goals/issues
· To be paid in full before scheduling first appointment
· Must be used within 30 days of purchase date
· A detailed report of notes will be electronically delivered to client after each session
Bulk Sessions available:
· 6 Sessions $430 (must be used within 6 months of purchase date, by same client)
· 10 Sessions $700 (must be used within 12 months of purchase date, by same client)
Reiki Sessions: $80
· 60-minute sessions to be performed in my home, or virtually via Zoom
Intuitive Reading: $45
· 30-minute Intuitive reading to be performed via phone or Zoom utilizing Tarot, Oracle, and other intuitive impressions received.