EMOTION CODE® CLIENT CONSENT & RELEASE

Overview

Jackie Long Hypnosis LLC provides the following services:

Hypnosis, medical support hypnosis, regression hypnosis, self-hypnosis training, and Emotion Code® sessions via virtual sessions online. This consent form is for The Emotion Code® only and for receiving Emotion Code® sessions.

The Emotion Code® is an energy healing technique created by Dr. Bradley Nelson that aims to identify and release trapped emotional energies from the body, supporting emotional balance, mental clarity, and overall well-being. This method is not a substitute for medical or mental health treatment and does not diagnose or treat medical or psychological conditions. More information about my Dr. Bradley Nelson and The Emotion Code® can be found at: www.discoverhealing.com

Disclaimer

The Emotion Code® is not intended to diagnose, cure, prevent, or treat any disease or medical condition. Information provided during sessions is for personal and energetic wellness support only.

Client Acknowledgments

I acknowledge and agree to the following:

  1. Voluntary Participation
    I understand that participation in Emotion Code® sessions is voluntary, and I may discontinue at any time.

  2. Not a Medical Treatment
    I understand that Emotion Code® practitioners are not physicians, psychologists, or licensed medical professionals unless otherwise stated, and this service is not intended to replace medical or therapeutic care.

  3. No Guarantees
    I understand that results vary from person to person, and no outcome is guaranteed.

  4. Personal Responsibility
    I am responsible for my own physical, mental, and emotional well-being before, during, and after sessions. I agree to seek appropriate professional care when needed.

  5. Confidentiality
    I understand that all personal information shared will remain confidential except in circumstances required by law.

  6. Energetic Release Reactions
    I understand that releasing trapped emotional energy may result in temporary emotional or physical sensations such as fatigue, emotional sensitivity, vivid dreams, or increased awareness.

  7. Self-Representation
    I confirm I am not experiencing severe mental distress requiring emergency or clinical intervention and will notify the practitioner if my needs exceed the scope of this work.

  8. Remote Sessions

    I acknowledge that Emotion Code® sessions may be conducted in person or remotely, and both are equally effective in energy-based work.

  9. Communication
    I consent to receiving communication from the practitioner related to my session via email, phone, and/or text message at the email address and phone number I provided.

  10. Permission to Proceed
    I consent to receiving Emotion Code® services from the practitioner and understand I may withdraw consent at any time.

Consent & Release

I understand that the Emotion Code® and other activities incidental or related to the foregoing (collectively, the “Energy Work Activities”) are not absolute sciences. I am of legal age, and in consideration of my acceptance as a participant in this Emotion Code® session, I, for myself, my heirs, executors, administrators, successors and assigns, do hereby release and discharge Jacqueline/Jackie Long and Jackie Long Hypnosis LLC and their shareholders, members, partners, officers, directors, managers, employees, executors, administrators, successors, assigns, and other participants in any Energy Work Activities, from any and all liability, damages, losses, suits, demands, claims, actions, and costs (including, without limitation, court costs and fees of attorneys, investigators, and experts), arising out of, or relating to, my, participation in Energy Work Activities conducted by, through, or involving, Jacqueline/Jackie Long and Jackie Long Hypnosis LLC.

I further agree and understand that Discover Healing does not offer a complaint-handling or dispute-resolution process for its practitioners and does not assume liability for practitioner services. Any concerns regarding the services provided must be addressed directly with the practitioner. If any such complaint or dispute is not settled by negotiation, I further agree to engage in non-binding mediation in the State of New York, County of Westchester, before an independent mediator mutually selected by the parties, in an attempt to resolve such complaint or dispute. Any unresolved complaint or dispute may thereafter be litigated in any state or federal court located in the State of New York, County of Westchester, and all parties hereby submit to the jurisdiction and venue of any such court.

I understand that all services provided by Jacqueline/Jackie Long and/or Jackie Long Hypnosis LLC are for educational and self-improvement purposes only. I further understand that those services are not the practice of medicine or psychotherapy and are, therefore, not offered as a replacement for counseling, psychotherapy, psychiatric or medical treatment. I understand that Jacqueline/Jackie Long and/or Jackie Long Hypnosis LLC has the right to refer me to an appropriate healthcare provider or refuse Emotion Code® services to me should my case be outside of their scope of practice as stated by law.

Acknowledgment & Consent

I confirm that:

  • I have read and fully understood the consent and release form;

  • I voluntarily agree to participate in Emotion Code® sessions;

  • I acknowledge this work is not a replacement for medical or mental health treatment;

  • I understand no specific results are guaranteed; and

  • I accept responsibility for my own well‑being.