TERMS and CONDITIONS

KAREN TAYLOR HYPNOTHERAPY
HPD DHP CBT (hyp) SFBT (hyp)

YEW TREE COTTAGE
UPOTTERY
DEVON
EX14 9QX

Disclosure and Consent Form for Hypnosis/Hypnotherapy

I, ________________________ have been advised by Karen Taylor what Hypnotherapy sessions involve and I give my full consent to receiving Hypnotherapy sessions by Karen Taylor. I understand that results vary and that the above name practitioner may not guarantee results.
Hypnotherapy is not a replacement for medical treatment, Psychological or Psychiatric Services or Counselling. I also understand that the Hypnotherapist does not treat, prescribe for, or diagnose any condition.
I am aware and understand that in some cases it may be necessary for Karen Taylor to respectfully touch my shoulder(s), hand, wrist, or forehead in order to assist me in relaxation. I give Karen Taylor permission and consent to do so in order to help me establish a beneficial state of hypnosis.
I have been advised that I am free to terminate any or all sessions at any time. I have agreed to participate in each session to the best of my ability.
I have accurately provided background information as requested by the hypnotherapist.
I understand that confidentially regarding my sessions will be honoured between my hypnotherapist and me. This same confidentially is respected when working with minors under the age of eighteen.
I commit to treatment and understand that if I do not attend a session without prior cancellation notice of 24 hours, I may be liable to pay a failure to attend fee of 50% of the session fee.

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Signature of Client Date

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Printed name of Parent or Guardian

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Signature of Parent or Guardian Date