Deep Change Hypnosis Client Disclosure Form
I understand that the results of hypnosis can vary from person to person and from session to session. As a result, it is impossible to guarantee any specific results.
I understand that hypnosis carries the risk of recalling unpleasant memories and that these memories could cause me to feel emotional pain. I accept this risk without reservation.
I understand that should I recall something while in a state of hypnosis that has any legal implications I should stop my hypnosis session because hypnotically-induced memories will not be accepted in a court of law and may instead negatively affect my ability to pursue any sort of legal action.
I understand that hypnosis is more like a dance between myself and the hypnotist and that my ability to follow directions and actively participate in the hypnosis sessions will directly effect the outcome. As a result I will do my best to insure that each hypnosis session is as successful as possible.
I understand that the hypnotist may be required to touch me on the hand, arm, shoulder or head in order to facilitate the hypnotic process.
I understand that hypnosis is not meant to replace medical or psychological care.
I understand that the hypnotist will not make any diagnosis and that I will not view anything that the hypnotist says or does as such.
I understand that the hypnotist cannot help me work on a medical or psychiatric condition unless I have a note signed by my physician, psychiatrist or licenced psychologist indicating that it is acceptable for me to use hypnosisto do so.
I understand that my hypnosis session may be video-recorded for my protection. This recording will belong to Deep Change Hypnosis and it can only be viewed by a Certified Consulting Hypnotist who is employed by Deep Change Hypnosis, unless I provide written consent to do otherwise. I further understand that I can purchase a copy of this video-recording for my private use and that Deep Change Hypnosis will retain the copyright to this recording.
I understand that I am free to stop my session or sessions at any point. I further understand that if I have purchased a series of sessions (a package) and I have decided that I no longer wish to use any that remain, that any hypnosis sessions I have already had will then be priced at the single session rate and I will be refunded any money that remains.
I understand that I am required to inform Deep Change Hypnosis 48-hours in advance if I need to cancel an appointment, otherwise I will be charged for the session.
I understand that anything that happens during my hypnosis session is strictly confidential and that Deep Change Hypnosis will not even reveal that I have been a client unless under a court order to do so.
Name:______
Signature:______
Date: ______