PLEASE TAKE YOUR TIME TO READ THE FOLLOWING CAREFULLY
I agree to be hypnotized for this session and any following sessions. This consent applies until revoked by me.
I understand that the Hypnotherapy is a complementary, therapy which means that any therapy or treatment provided to me should be complementary with or in addition to a medical course of treatment or therapy administered under medical care.
the Hypnotherapist does not offer diagnosis and any perceived diagnosis should not be relied on by me. I should consult a registered medical practitioner for diagnosis. This includes if I have perceived that I have been diagnosed by the Hypnotherapist.
I agree that the Hypnotherapist shall be excluded from liability in tort or negligence to the fullest extent permissible by law with respect to any harm which is not reasonably foreseeable by the therapist.
I understand that the Hypnotherapist is not responsible if therapy or treatment does not have the effect anticipated by me. Therapy may require more than one session to be effective however I understand that I am under no obligation to have more than one. If I choose to have any treatment (one session or more), that is in exercise of my own free will and at my own risk.
I agree that I will pay to the Hypnotherapist the full fee in respect of any consultation at the conclusion of each consultation.
I acknowledge that the Hypnotherapist can refuse service to any person(s) at any time at the Hypnotherapist discretion. Where possible the Hypnotherapist will refer me to another practitioner (if appropriate).
I state that all information provided is a true and accurate record.
PRIVACY OF INFORMATION
I authorize the Hypnotherapist to make notes and use information about me for the purpose of the Hypnotherapist business. Should the Hypnotherapist deem necessary.
The Hypnotherapist is not authorized to disclose any information about me without my written consent except as required by law, or for the purposes of debt collection, or when failure to do so could constitute a danger or menace to myself or any person(s).
The Privacy Act 1988 entitles me access to and if necessary to request correction of personal information that the Hypnotherapist holds about me.
I understand that recording of any hypnotherapy session(s) is not permitted.
I acknowledge by signing below that I have read and agree with /to the above consent/notice/disclaimer/privacy clauses. In the event that I take issue with any clause above, I should draw this objection to the attention of the Hypnotherapist immediately.