Access Bars Consent Form

I (as named above)...

1. understand that the Bars® session provided by Eloise Ansell is intended to enhance relaxation & by gently touching points on my head may help to release the electromagnetic charge of all thoughts, ideas, attitudes, decisions, and beliefs that I may hold.

2. acknowledge that Access Consciousness M is non-invasive & safe.

3. understand that participation in a session with Eloise is voluntary and that at any time I may choose to end
my participation.

4. understand that so-called de-toxification symptoms or release during the 24-48 hours following the session
may be experienced, particularly if you have been experiencing chronic or heightened levels of stress.
understand that Bars sessions are not a substitute for medical treatment or medications.

5. am aware that Eloise Ansell does not diagnose nor does she prescribe medication.

6. am aware that any medical issues or concerns should be addressed with a qualified doctor.

7. Understand that information exchanged during any session is educational in nature and is intended to help
me become more familiar and conscious of my own health status and is to be used at my own discretion.
agree to pay the agreed fee per session and I understand that a 24-hour cancellation notice is required to
avoid a fee.

8. understand my email will be added to Eloise's mailing list and agree to receive emails. This includes ones of
a marketing nature as well as up-to-date information regarding Eloise's services. Eloise will not share my
information with 3rd parties & keep my data safe. I understand I can cancel this service at any time.

I understand that for a free cancellation for sessions, I will inform you (by phone/text) at least 24 hours prior to
the appointment. I will be charged 50% of usual price for not attending without the required notice or for
cancelling on the day of my appointment.

I understand that the information on this form and any information imparted during these sessions are strictly
confidential in nature and will not be shared with anyone without my written permission. General information,
excluding my name, may be used to help others further understand the efficacy and use of Bars.