Edson Emotion Reset: Emotion Code /Body Code/PSYCH-K Request Form
Please Read/Accept Terms and Conditions:

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 bodyʼs 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 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 counselling 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, or taking any supplements the body identifies 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 province 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.

8. I understand that I am advised to be self-informed about this work by reading his book The Emotion Code and/or visiting Dr. Bradley Nelson's website:
https://discoverhealing.com/ref/qrdvz/


9. I understand that I am responsible to pay for the service via e-transfer to edsonemotionreset@gmail.com Once an appointment has been booked and completed, I understand there are no refunds for this service.

10. I understand that my client report will be emailed to be with 24 hours of the session taking place.

11. I understand that the Emotion Code practitioner, Jocelyn Pettitt, has the right to refuse this request if muscle testing is not viable on a client, or if muscle testing suggests that Emotion Code will not be a good fit for this client/practitioner relationship.

12. I understand that by signing this form, I fully consent to participate in Emotion Code/Body Code and/or PSYCH-K session(s) with Jocelyn Pettitt.
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Email *
I have read and accepted the terms and conditions. By saying "Yes", It is considered your electronic signature to the above terms. *
First Name *
Last Name *
Age *
Where do you live? Province/State, Country, Time Zone *
Date of Birth *
MM
/
DD
/
YYYY
Phone number to arrange a phone consult and/or booking. *
Gender *
Do you have Children? If so, how many? Please provide initials or names if you would like to identify Inherited Emotion lineage.
Have you had an Emotion Code or Body Code Session before? *
How did you hear of Edson Emotion Reset *
Please indicate if you have any of these health issues? Check all that apply.
Column 1
Relationship Difficulties
Limiting Beliefs
Anxiety
Depression
Sadness
Fear
Anger
Frustration
Difficulty Sleeping
Phobia (describe in additional comments)
Please list any physical pain that you would like to investigate.
Stress Level *
Being no stress
Highest level of stress imaginable
Any specific areas of concern for this session?
Pain Level of Area of Concern
Being no pain
Highest level of pain imaginable
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Are you currently pregnant? *
Do you have a heart condition? If yes, please explain. *
Do you have any of these devices? *
Do you have any allergies? If so, please list.
Are you filling out this form as the guardian of a minor or pet? If yes, please provide the name of minor and the relationship in "Additional Information Section". *
Additional Information: Do you have any other information you would like to share before the session?
A copy of your responses will be emailed to the address you provided.
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