Consent Form
  • Client's Consent For Sessions with Dana Engdahl, Inc. dba Heal With Dana

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  • Education and Training:

    I am certified in both Emotion Code and Body Code. In addition to these certifications, I participated in a mentorship program and worked extensively with Dr. Nelson and his trainers for over a year to fully develop my understanding and skill in Emotion Code and Body Code.  I am also trained to facilitate Psych-K balances completing all 4 courses, including the Health and Well-being Program.

    Basic Description of Emotion Code/Body Code Services and Techniques:

    The Emotion Code/Body Code techniques are a simple way to get rid of your emotional baggage, helping you feel freer, happier and healthier!  Because the body is actually made of pure energy, the negative energy of trapped emotions can exert a damaging force on the body, which worsens over time. Trapped Emotions cause pain, self-sabotage, emotional problems and all kinds of malfunction and disease.

    The Body Code is a state of the art healing technique bringing balance in six different ways:

     *  Energy: To correct this area of imbalance I use energy work to identify and remove damaging emotional and mental energies that can become trapped in the body during stressful emotional events.

    *  Circuitry: Here I balance the energy systems of the body including the chakras, the acupuncture meridians, the connection of the spiritual and physical body and the energy circuits of the organs and glands.

    *  Toxicity: The Body Code can identify and address toxic agents that don’t show up on medical tests as well as those that do. Removing them is simple and often immediate.

    *  Pathogens: Destructive and often elusive infections can be easily identified along with any necessary remedies to rid the body of them.

    *  Structural: Imbalance in the bones, organs, connective tissue, muscles and nerves can be treated non-invasively to gently restore stability to the physical body.

    *  Nutritional: This can be straightforward nutrient deficiency as well as imbalances like dehydration, magnetic field deficiency or a need for a certain healing food.

    Basic Description of Psych-K:

    Psych-K is a simple and direct way to change self-limiting beliefs at the subconscious level of the mind, where nearly all human behavior – both constructive and destructive originates.  A Psych-K balance is a process designed to create a balanced identification with both hemispheres of the brain.  This ‘whole brain state’ is ideal for reprograming the mind with new self-enhancing beliefs, reducing unwanted stress and helping you to access your ‘full response potential’ in meeting life’s challenges.

      

    Disclosure of health information:

    I ask for full disclosure of any health information that might impact your treatments (such as pregnancy) or physical limitations (like breathing or extreme pain issues).  Dana Engdahl, Inc. and Heal With Dana cannot be held responsible for any information not disclosed to her regarding current and past medical or emotional conditions.

                                 

    Confidentiality of records and Clients Rights:

    At any time, you have the right to discontinue services, change consent, or leave.  You also have the right to ask any question about your session.  Your client information and records are treated in a confidential manner.  Your experiences during these sessions are confidential subject to the usual exceptions governed by State or federal laws and regulations.  Confidentiality is subject to the following exceptions:

    1.  You may instruct me to release information to other health care practitioners in writing.

    2.  I may release information if subpoenaed or otherwise am obligated or reasonably allowed to do so (including circumstances where there is clear and imminent danger to yourself or another person.)

    3.  Your confidential personal file is kept in a secure location and is retained for 4 years after you suspend services after which time all information will be destroyed in a proper manner.

    4.  Your confidentiality is always subject to the usual exclusions dictated by state and federal laws and regulations.

     

    Release of Liability

    Emotion Code/Body Code and Psych –K balancing are gentle, complementary energy based approaches to health and healing that can assist your body in its natural ability to heal.  This may be accomplished through the use of some light contact to belief points on the front of the body and in the back.  You may decline any physical contact, change your consent to any physical contact at any time, or leave. Should you choose not to have any physical contact, you have the option to give consent for Dana Engdahl (Inc.) and Heal With Dana to act as “proxy or surrogate” for you so that you may still enjoy the benefits of a session.

    Emotion Code/Body Code and Psych-K services through Dana Engdahl (Inc.) and Heal With Dana is a complementary therapy not intended to replace any currently prescribed medical treatments as ordered by your physicians nor any other medical care you have or may be advised to seek.  Services with Dana Engdahl (Inc.) and Heal With Dana is not medical advice or medical treatment and is not meant to replace medical advice of your doctor.  You will be encouraged to consult a licensed medical practitioner for any physical or mental complaints you may have. 

    While Emotion Code/Body Code and Psych-k are gentle, complementary energy based approaches, there may be risks.  Most people process the energy released very easily.  However, occasionally, there may be some symptoms that come along with processing that you need to be aware of. Usually this is something minor, such as emotional irritability or a little fatigue, but it could end up being something more uncomfortable like headache or nausea. It all depends on what we released, what's going on with your body at the time, your stress level at the time and many other external factors. You can make the processing period easier by getting extra sleep the night before, drinking a lot of pure water, and avoiding stressful situations.  All energies released are intended to release gently and peacefully.

    All client information and records are treated in a confidential manner.  Your experiences during these sessions are confidential subject to the usual exceptions governed by Washington State or federal laws and regulations.

    Except in the case of gross negligence or malpractice, you or your representative agrees to fully release and hold harmless Heal with Dana, Dana Engdhal and Dana Engdahl (Inc.) for and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session.

    1.  My questions have been answered to my satisfaction regarding Heal with Dana and Dana Engdahl’s background.

    2.  If I am a phone-in/Skype or Zoom client, I understand that when paying for services, I fully consent to the services offered by Dana Engdahl (Inc.) and Heal With Dana.

    3. I agree to allow Dana Engdahl (Inc.) and Heal With Dana to send me information via e-mail.  I understand that my e-mail address will be kept confidential and will not be given to any other party.

     

    By signing below, I fully consent to use the services offered by Dana Engdahl, Inc. and Heal With Dana.

     

     

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  • By signing below, I fully consent to use of services offered by Dana Engdahl and Heal With Dana LLC for my child who is a minor:

     

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