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 proper 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 CNCH, a Department of Health supported Register of which Charlotte Spillane 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.
  • I accept the fee payable and note the 24 hours’ notice of cancellation that is required.
  • A respectful relationship will be maintained between the client and the therapist.

    I have read the above agreement and accept the treatment on those terms:
    YesNo

    I have confirmed that I have read the GDPR Terms and Conditions and am aware of how my data will be processed and stored:
    YesNo

    GP Practice:

    Medication details:

    I am happy for you to contact my GP:
    YesNo

    Your name:

    Your email:

    Date:

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