Consent Form

If you are a new client, please electronically sign this consent form before our first appointment.

Statement of Consent

I understand that Jennifer Elmore is a naturalist who is researching the effects of flower essences on the human energy system and is not a trained medical professional. I understand that Jennifer Elmore does not claim to diagnose, treat or cure any medical or psychological conditions, and I understand that flower essences are not to be used as a substitute for traditional medical care.

I acknowledge that Jennifer Elmore accepts no responsibility for my health or health-related decisions. I do not hold Jennifer Elmore responsible for my physical or emotional well-being, and I agree to consult with a trained medical professional to guide my health care decisions.

I am aware that flower essences are often preserved in alcohol, and I do not hold Jennifer Elmore responsible for any liability regarding the alcohol content of the products she uses.


Payment

The fee for a 60-minute consultation + flower essence blend is $100. 

The fee for a 60-minute consultation/energy session + flower essence blend is $145.

Payment is due at the time of service. Jennifer accepts cash, check, PayPal, and Venmo.

Please fill out the form below to acknowledge that you have read and fully understand this waiver and that you accept any risk, should you decide to consult with Jennifer Elmore.

I have read the above disclaimer, and I fully understand and accept all of its terms and conditions.

Thanks for submitting!