Client Consent Form for Work with Eliza Carroll MS, Spiritual Healer
Please note that this form is only required for live, in-person sessions, and
another consent form is available for when I work as a Spiritual
Counselor/Spiritual Healer in tandem. Please skip this if you are requesting
remote (non-local) healing services. Eliza Carroll MS is a spiritual healer, also
sometimes known as a subtle energy healer. She is highly intuitive and offers
non-contact, nonlocal spiritual healing either at a distance, usually arranged
and coordinated by telephone, or in person.
Eliza has drawn up a client consent form to ensure that clients understand the nature of
the spiritual healing relationship. I ask that all clients who wish to start work with me in a
live session (versus remote sessions) sign a consent form which I have reproduced
below. Please feel free to print the form below (alternatively, I have printed copies in my
office for your use) and then sign and return it. Thank you!
I, the undersigned, understand that:
1) This practitioner is not acting as a medical doctor, psychologist, psychotherapist or
chiropractor in her spirit releasement/spiritual healing sessions. This practitioner does
not claim to be a licensed health care provider of any sort. This practitioner does not
take any legal or clinical responsibility for the health or welfare or health care of the
client.
2) This work is never offered as a replacement or substitute for conventional medical or
behavioral health care treatment, but rather as an ancillary modality.
3) This work is seen only as discipline which is complementary to any and all accepted
medical and alternative practices, rather than claiming to be an alternative to any such
practice.
4) This practitioner does not represent himself/herself as a licensed health care
provider while acting as a spiritual healer, and rather only as a provider of an ancillary,
optional service. The licensed health care providers which a client has engaged are the
only entities who are legally and clinically accountable for the health and welfare of the
client.
5) If a client is referred to the spiritual healer by a licensed health care provider, the
client and provider must realize that the licensed health care providers which a client has
engaged are the only entities who are legally and clinically accountable for the health
and welfare of the client.
6) Clients will always remain fully clothed during a session, although they are welcome
to remove bulky outer clothing such as jackets or sweaters, as needed to make
themselves comfortable.
7) No third party, including apprentices, assistants or members of the client’s family,
may be present during the course of a session with an adult client without the express
consent of the client.
8) Spiritual healers never touch the skin or person of a human client during the session,
and never use manipulation, massage, or other forms of direct contact.
9) All information given to a spiritual healing practitioner is confidential. Information will
only be disclosed with express consent of the client, or if demanded by a legal authority
whom the practitioner believes to have legal right to the information.
10) Any spiritual healing work done with anyone under the age of 18, will only be done
with the approval of parent or guardian, and any and all sessions will take place only
when and if a parent or legal guardian is present at every moment.
11) The practitioner does not claim or represent that they will successfully cure or
remediate any physical or behavioral health care problem. Rather, this is a supportive
modality.
12) I understand that Eliza's method does not claim to cure or fix any ailment, but rather
to offer a deeper sense of connectedness with grace and ease, and a deeper ability to
meet life's challenges.
13) I understand that Eliza Carroll MS does not offer diagnosis, treatment or cure for
any disease or disorder while acting as a spiritual healer, but rather deep support at a
spiritual level.
14) I understand that, regardless of any testimonials or reports of client healings, Eliza
Carroll MS does not claim to offer miracle cures or magical healing, but rather simply
offers treatment which apparently affects only in a subtle and gentle way the very subtle
energy fields of body, mind and spirit.
15) I, the undersigned, do not hold Eliza Carroll MS legally or clinically responsible for
any aspect of my physical or behavioral health or care thereof.
16) I understand that if I or the intended client have a serious physical or behavioral
health problem that I or the client am/are expected to be working with a licensed and
qualified conventional or alternative provider. I understand that this spiritual work does
not replace such therapies.
17) I certify that if I or the intended client have a serious physical or behavioral health
disorder, that I or they are under the care of a qualified and licensed medical or
alternative practitioner. I understand that one is not required to have a license to
practice counseling in the State of Oregon, and that Eliza Carroll MS is not acting also as
a spiritual counselor until I have signed a client “Informed Consent” form for her spiritual
counseling practice.
Please note that this form is only required for live, in-person sessions. Another
form is available to cover sessions where Eliza Carroll MS is acting as a
psychotherapist in concert with spiritual healing. Please skip this if you are
requesting remote (non-local) healing services.
I have read and I understand all the statements above, and I agree to these terms. I
certify that if I or the person for whom I request treatment have a serious diagnosable
physical or behavioral health condition, that I or they am/are under the care of a licensed
professional health care provider. I agree that I will not terminate conventional or
alternative medical treatment with a licensed and qualified provider as a result of this
work.
I request Eliza Carroll MS to perform spiritual healing sessions with (please check one):
____ myself
____ someone else, named: ____________________________ (please print name)
Signed__________________ Printed name ___________________ Date _______
Witness__________________ Printed name___________________ Date_______
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