Release Form

RELEASE STATEMENT

I,_____________________,(client/guardian’s name) understand that nothing said, done, performed, typed, printed or produced by Peggy Nazer is intended or meant to diagnose, prescribe, treat a disease or take the place of diagnoses by a licensed physician, psychologist or psychiatrist.  Consultations by phone or email, trainings, coursework, coaching sessions, energy work sessions, processing sessions, integration sessions, classes or techniques are to promote healthy lifestyles and cultivate the mind/body connection.

A variety of non-invasive methods, modalities and programs may be used which include but are not limited to, bio-kinesiology (muscle response testing-MRT) MRT is used to determine past events and identify negative emotions that are being stored in certain chakras or energy centers of the body.

Guided imagery, NLP, speaking out feelings, role playing, inner child work, chakra work, visualization and various energy clearing techniques are used.  The purpose in using these techniques is to bring the client to a place of inner healing and a strong sense of well-being and closure with the issues being addressed.

This form is a release form granting Peggy Nazer permission to release and clear negative energy and process you or your family member through experiences using both conscious awareness and energy release techniques.  This authorization is valid for any and all private and group sessions as well as any coursework involving Peggy Nazer.

Client/Guardian’s signature:_____________________________________

Date:_______________________________________________________