New Clients Please Complete

 

      

HYPNOTHERAPY INFORMATION AND CONSENT FORM

What is hypnotherapy?

Hypnotherapy is a guided experience of focused attention, or a trance-like state achieved with the help of a clinical hypnotherapist. This trance-like state is similar to being completely absorbed in a book, movie, music, or even one's own thoughts. In this state, clients are guided to utilize the natural resources deep within themselves that can help them make changes or regain control in certain areas of their life. Clinical hypnotherapy can assist you in many ways and it can add to whatever other supports/medications that you may already have in place for your well-being. Hypnotic suggestions will never put you in danger. 

What will happen when I see a hypnotherapist?

The amount of time spent seeing a hypnotherapist will vary for different people. Your initial 30-minute session is free which enables me to find out more about you and will help me to work out what treatment options are the best to meet your needs. The initial session also enables you to ask questions and to decide if you want to proceed with treatment. Further sessions can last for 50 to 90 minutes but are guided by your needs at the time.

Confidentiality

All issues discussed in session remain confidential in line with my professional code of ethics and the Privacy Act (1993). There are some limits to this confidentiality, with the main limit being safety.  This means that if your psychologist is concerned about your safety, or that of others, they may need to break confidentiality to provide appropriate help.  Where possible they will discuss this with you first. It may be necessary to contact other treatment providers including your GP, this is only done with your consent.

To make sure we are doing the best job possible, hypnotherapists have regular supervision. This means discussing some aspects of their work with a supervisor or colleagues. When this happens, the identity of a client is kept as anonymous as possible. Every hypnotherapist keeps a written and/or audio records of sessions and these records are stored safely to ensure your privacy.

Satisfaction and Complaints

If you are unhappy with any aspect of your therapy, it is important to let me know. You can approach me directly, but if you prefer, you can contact the Health and Disability Commissioner (0800 112233), or Advocacy Network Services (0800 423638).

Fees

Each session fee is payable on the session day as per fee structure provided. As my services are in high demand it is asked that wherever possible you give 24 hours’ notice if you are unable to attend an appointment. Where less than 24 hours’ notice cancellation is given then the full fee may be payable.

 

By submitting this form you agree that: 

  • I have read and understand the above information and what is expected of me.
  • I give my consent to be contacted by Life Therapy.
  • I have the right to decline part or all of the treatment offered to me at any time.
  • I undertake to pay for the full cost of treatment as per Fee Structure.
  • I agree to pay in full for missed appointments of less than 24 hours notice.