Consent Form

Jun 17, 2021


** I (as named)

  • understand that the sessions provided by Eloise Ansell are intended to enhance relaxation, increase communication within areas of the body, and to educate me to possible energetic or emotional blocks that may create pain and disease.
  • acknowledge that the modalities Eloise uses are non-invasive, safe, and objective and that it utilises the body’s own innate intelligence to reestablish communication within itself.
  • understand that participation in a session with Eloise is voluntary and that at any time I may choose to end my participation.
  • understand that so-called “detoxification 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 sessions are not a substitute for medical treatment or medications.
  • am aware that Eloise Ansell does not diagnose nor does she prescribe medication.
  • am aware that any medical issues or concerns should be addressed with a qualified doctor.
  • 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.
  • understand that there are no refunds for sessions.
  • agree to pay the agreed fee per session for anything up to 40 minutes in duration (sessions can last 10 mins) and I understand that a 24-hour cancellation notice is required to avoid a fee.
  • understand Eloise may record audios & written notes of the sessions for her records.
  • 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 3 parties & keep my data safe. I understand I can cancel this service at any time.


Cancellation policy:

I understand that for a free cancellation for in-person or distance (remote) sessions, I will inform you (by phone/text) at least 24 hours prior to the appointment.  I will be charged 50% of the usual price for not attending without the required notice or for cancelling on the day of my appointment. I understand a remote session is always available if you cannot attend in person.


Confidentiality policy:

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 sessions.