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Client Consent Form

Client Agreement – Code of Care

  • The client will be treated with respect at all times.

  • Disclosure of all information during the Initial Consultation and subsequent sessions will remain confidential.

  • The hypnotherapist has a professional obligation to report to relevant authorities any concerns they believe where the client may intend to harm themselves, the therapist or others.

  • If the client is receiving medical treatment then a diagnosis must be sought when possible, and health professionals may be informed of hypnotherapy treatment.

  • A copy of the Association for Solution Focused Hypnotherapy Code of practice is readily available.

  • This complies with that of the NCH, a Department of Health supported Register of which Elizabeth Smitheram is a member.


Consent for Treatment

  • The therapist has fully explained the procedures and treatment.

  • I understand that listening to the track every night is an important and essential aspect to the treatment.

  • I understand the success of the treatment, in part, is determined by the desire to achieve the changes and the commitment to the format of the sessions.

  • A respectful relationship will be maintained between the client and the therapist.

  • By signing this consent form, I understand that this is a complementary therapy and is not a substitute for medical advice or / and treatment. I will continue with any treatment prescribed by my GP or specialist. I confirm that the information given has been completed to the best of my knowledge and belief. I understand the treatment and wish to proceed.


Cancellation Policy

  • I operate a busy practice. Please be considerate when cancelling an appointment, and where possible give at least 48 hours notice.

  • The appointment fee will be charged in full, if there is less than 24 hours cancellation notice given.

I have read the above agreement and accept the treatment on those terms:
Yes
No
I am happy for you to contact my GP:
Yes
No
I confirm that I have read the GDPR Terms and Conditions and I am aware of how my data will be processed and stored:
Yes
No
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