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 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: 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.