By signing this form you are in agreement that you have read and agree to terms and conditions of this form.
You are in agreement that you have read the contraindications in this document.
You can confirm that you have doctor’s approval if you have a particular condition.
Contraindications for most people, hypnotherapy is a pleasant, gentle, and extremely safe experience. However, your safety is my number one concern and there are occasions where hypnosis would be contraindicated. That means there may be a risk. If you have any medical condition, please ask your doctor to give their approval before confirming your booking with me.
Contradictions:
I cannot work with you if you have a diagnosis of:
● Psychosis
● Schizophrenia
● Pathological personality disorder
● Senility I may be able to work with you if you have epilepsy, narcolepsy, depression, asthma, or a heart condition, but will require your doctor’s approval.
Confidentiality:
Confidentiality is within our relationship and within my relationship with my supervisor (your personal details i.e. your name and address are not discussed in supervision). I will discuss any breach of this confidentiality with you in the first instance, except terrorist action or unless I believe you are in danger to yourself or others and unable to negotiate with me. If I see you somewhere outside of our sessions, to ensure your confidentiality, I will not approach you or act as if I know you. However, if you acknowledge me then I will acknowledge you. Although the therapeutic relationship is friendly, it is not the same as a friendship, so in order to maintain our therapeutic space as the confidential and safe experience that you deserve, I avoid any kind of dual relationship with current and former clients. I may keep short digital notes from our sessions. Should notes be made, they are kept confidential and are stored in a safe, secure place.
Physical Contact:
Occasionally some interventions require direct touch e.g. lifting a wrist. I will always ask your permission and explain exactly what and where the physical contact will occur prior to every occurrence. You may choose for us to work together entirely without touch; if you would prefer to do so, please let me know at the beginning of the session.
Memory recovery:
On occasion therapy involves the experience of seeming to remember a past event. It should be noted that any information remembered in this way has as much chance of being false, as it does being based on an actual event. We will keep this kind of work to an absolute minimum.
Cancellation & Late Attendance:
Please give me as much notice as possible for the cancellation. For cancellations with less than 24 hours’ notice the full fee will be payable. If you are late for your appointment we will still need to finish by the allotted time. If you arrive for treatment under the influence of mind-altering drugs or alcohol, the session will be suspended, and the full fee charged. Further sessions will be at the therapist’s discretion and may be cancelled permanently. If I think you would benefit from being referred to another therapist or specialist, we will agree to make the referral as soon as possible. I reserve the right to cancel therapy at any time and to refuse prospective clients at my own discretion.
