Name *

First Name

Last Name

How old is the person being processed? *

Under 18

18 or Older

Client Consent *

I understand that nothing said, done, performed typed, printed or produced by Sara J Thacker, is intended or meant to diagnose, prescribe, treat a disease or take the place of diagnoses by a licensed physician, psychologist or psychiatrist. I understand that Processing sessions and techiniques used by Sara J. Thacker are intended only to promote healthy lifestyle and cultivate the mind/body connection. I understand that in an emotional processing session, a variety of non-invasive methods, modalities, and programs may be used, including, but not limited to, bio-kinesiology (muscle response testing), guided imagery, NLP (neuro-linguistic programming), speaking out feelings, role play, inner child work, chakra work and visualization. I understand that it is the purpose of the facilitator in using these techniques to bring the client to a place of inner healing , and to create a strong sense of well-being and closure with the issues being addressed, I understand that this form is a release form granting my permission for a facilitator to process my family member, a person for whom I am a legal guardian, or myself, using the four-step process. This authorization is valid for the person named on this form, for any and all sessions of processing with Sara J Thacker. I hereby assume full responsibility for arranging the emotional processing sessions for the person named on this form, and release and discharge Sara J. Thacker from any and all claims, liabilities, damages, actions, or causes of action arising from the services received hereunder.

I give my consent

I do NOT give my consen