General Office Form

General Release

Before undergoing hypnosis, you should be aware of the following information:

1. I am not a medical doctor or a psychologist and I do not hold any medical degrees.
2. I am a Hypnosis Consultant and Instructor. I have learned my occupation through independent study and practical application.
3. A subject comes to hypnosis with certain problems that he or she wishes to solve or overcome. A Hypnosis Consultant teaches you to enter the hypnotic state and provides you with hypnotic suggestions, designed by you, that will hopefully enable you to reach your desired goals.
4. When undergoing hypnosis, you are not purchasing medical or psychological advice or treatment. You are purchasing the Consultant’s time and expertise to aid you in entering the hypnotic state.
5. You may find your Hypnosis Consultant giving you advice before or after the termination of the hypnotic state. Such advice is to be taken on a personal and non-professional basis. It should not be construed in any manner to substitute or eliminate your physician’s, psychiatrist’s or psychologist’s advice.
6. A Hypnosis Consultant does not do any of the following:
   • a. treat or give relief of any wound, fracture or bodily injury, illness or disease.
   • b. give psychological assessments, such as intelligence, personality, aptitude or attitude appraisals.
   • c. give psychological treatment of persons who have adjustment problems.
   • d. give medical or psychological treatment or advice. If you are having medical or psychological problems, you should consult your physician
7. A Hypnosis Consultant merely teaches you to enter the hypnotic state. While in the hypnotic state, suggestions , that have been designed by you, will be given to your subconscious mind to aid you in obtaining your goals and objectives. Think of your Hypnosis Consultant as nothing more than a guide to aid you in an effort to take full advantage of your total mind power.

By clicking the "Submit" button below, I understand that the fee I pay is for the hypnotherapist’s time, not for a guarantee of results, and I have read The Mental Health Client Bill of Rights provided on this form and I fully understand its contents.