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Consent, Acknowledgement, and Liability Release Form

For Energetic Balancing Work with Jessica Mockett

I understand that The Emotion Code, Body Code System, Belief Code as taught and certified by Dr. Bradley Nelson, Emotional Freedom Technique or tapping as learned from Nick Ortner, spiritual mentoring, supportive tools via affirmations, visualizations, or meditations (hereinafter called “these methods”), and as practiced by the practitioner, Jessica Mockett, seek to identify and eliminate underlying imbalances by releasing energetic imbalances in the areas of energy, circuitry, pathogens, structure, toxicity, and nutrition and to help clients work towards healthier physical, emotional, mental, and spiritual processing. 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, Jessica Mockett, 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 as a replacement for any needful professional psycho-therapeutic or counseling sessions in the treatment of any mental health issues or disorders. I understand that Jessica Mockett does not handle medical or mental health emergencies.

I understand that if my practitioner, Jessica Mockett, 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 here that I seek the advice of a qualified nutritionist or 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 these methods may not be FDA registered or approved and are considered as alternative or experimental forms of therapies and are to be used as complimentary care in conjunction with other healthcare as needed. 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 and agree on behalf or myself, my dependents, heirs, administrators, legal representatives, and assignees, that except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Jessica Mockett from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

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 these sessions/methods are offered as an alternative therapeutic service and are not meant to replace any medical treatment.

I accept that while Jessica Mockett will keep my sessions confidential, there is not an official or legal confidentiality between an energy healer and client as there is between a medical doctor or a lawyer and their patients/clients. Should my client records be subpoenaed, or otherwise required by law, Jessica Mockett must comply. Also, I understand that should we have online sessions, email correspondence, phone calls, or text message exchanges that these forms of communication are not secured, nor encrypted. While Jessica will never openly share my name with associated sessions and results, she may utilize examples or outcomes from my sessions as case study examples in her writings or work in an anonymous capacity, unless she otherwise seeks written permission to use my personal identity in her writings or works.

I understand that I am advised to be self-informed about these methods by visiting Dr. Bradley Nelson's website: www.discoverhealing.com and/or by reading his books The Emotion Code or The Body Code.

I understand that by agreeing this form, I fully consent to participating in these methods and session(s) with Jessica Mockett.