Ananda Wellness
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Appointment Consent Form

ANANDA WELLNESS

Client Record & Consent Form

Rear 137, Station St. Fairfield. VIC 3078. Tel: (04) 21674093; ABN: 65972507258

 

Please Note: These forms are confidential and the information you provide will be used for therapy treatment only. Please complete this form in as much detail as possible so that we are able to provide you with an appropriate therapy treatment.

TERMS OF SERVICE:

Fees: Your service fees will be agreed upon prior to the consultation or treatment

Specific terms of service:

  • You are required to complete a health history form prior to the service

  • Any feedback during treatment specifically related to pain or discomfort is encouraged

  • Late arrivals will lead to a reduction in consultation time

  • If you would like to reschedule or cancel your booking please provide at least 24 hours notice. Failure to arrive for your appointment will incur a cancellation fee of 50% of the treatment fee

Privacy Policy

Any treatment or information shared during your session will be held in the strictest confidentiality. All information discussed will not be disclosed to a third party unless forced to do so through legal action. In certain circumstances Ananda Wellness Australia may ask your permission to contact your primary physician or other healthcare provider regarding a pertinent medical condition in order to give you the most appropriate level of care.