In compliance with the requirements of the California alternative health care law SB577, this disclosure provides information for any individual and/or group considering and/or consenting to receive my service(s). I, Jaimis Ulrich, affirm that I am not a California licensed mental health practitioner or physician. I do not provide psychotherapy or any other form of mental health service which would require a California state license, and I do not hold myself out to provide such services. I do not provide diagnosis or treatment of physical or mental conditions. I am not licensed by the state as a healing arts practitioner.
I, Jaimis Ulrich, am a Certified Hypnotherapist (CHt) and a certified member of the International Association of Counselors and Therapists (IACT). Again, at no time will I attempt to provide medical or mental health therapy or advice. By agreeing to work with me, you are providing consent indicating that hypnosis is appropriate for you and does not conflict with any existing medical or psychiatric treatment. For those currently receiving medical or psychiatric treatment, always seek out and follow the advice of your physician or other professional medical practitioner before considering the addition of a complimentary service such as hypnosis/hypnotherapy.
Participating in Hypnotherapy / Hypnosis / HypnoCoaching may result in several benefits, including, but not limited to, increased relaxation, an increase in positive thoughts and self-image, tools for self-efficacy and agency, improved interpersonal relationships, increased comfort in social, work, and family settings, increased capacity for intimacy with others, and increased self-confidence. There is no guarantee that Hypnotherapy / Hypnosis / HypnoCoaching will yield any or all the benefits listed above.
It is important for you to understand that the process of hypnosis is a joint effort between you, and your HypnoCoach (Jaimis Ulrich). Progress and success may vary depending upon the problems or issues being addressed*, as well as various other factors including but not limited to the amount of effort you are committed to invest, an active and willing participation in the hypnosis process, honesty, and a genuine desire to change the limiting beliefs, feelings, thoughts, and/or behaviors that you indicated needed improvement during our initial discussion.
The purpose of our discussions serves as an opportunity to better, and more deeply, understand yourself, as well as identify any potential limiting beliefs, problems, or difficulties you may be experiencing. This is important for understanding any possible barrier(s) preventing you from achieving the changes and outcomes you desire for experiencing life and relationships more fully. Because of this, discussions while participating in Hypnotherapy / Hypnosis / HypnoCoaching may involve some discomfort as a wide variety of issues, events, experiences, and/or memories—that are not always pleasant—are explored.
You may find that you feel worse before you feel better as thinking about unpleasant events, feelings, experiences, and situations that evoke strong emotions may occur. Remember that Personal growth and change take time. For some clients, the experience may seem easy and swift, slow, and frustrating, or something else entirely. Just know that my number one concern is you. Your safety and security are most important to me. If at any time during the process you would like to stop, or feel uncomfortable, need to take a break, please let me know. Although working on change will push you out of your comfort zone, engaging with that discomfort needs to be done through your own consent and desire to do so. Never engage in any activity that you do not agree with and/or are not comfortable participating in.
Please feel free to address any concerns you may have with me. I am a firm believer in open and honest communication, providing a safe space where you can experience the benefits of hypnosis comfortably and safely.
Confidentiality
As a member of the International Association of Counselors and Therapists (IACT), I have agreed to maintain strict confidentiality within the client/practitioner relationship consistent with the good care of the client and the laws of the land and ensure that any client notes and records be kept secure and confidential. The only exceptions are: When the client has given their permission to disclose information in writing, where the law requires disclosure, and when discussing information with fellow professionals where anonymity must be guaranteed. The question of confidentiality also applies to client records, computerized records, and any audio or video recording. I must have the client’s written permission to electronically record them. If the client is a minor a parent or the legal guardian must give written permission. With any information or case histories used for training or commercial purposes the client’s identity must be protected completely (International Association of Counselors and Therapists Code of Ethics (hypnosisalliance.com).
Cancellation Policy
Advanced notification to change or cancel an appointment is required. Cancellations will be accepted until 10:00 PM the night before an appointment. Cancellations by email must be confirmed before that time to be accepted. Late cancellations should be made by telephone to ensure that they have been received. If you fail to give sufficient notice of a cancellation you will be charged your regular fee for that session. As a courtesy, please give as much notice as possible. Tentative notice is also appreciated.
Payment Policy
Fees are due at the time that the service is provided. Payment in advance may also be made for multiple sessions. Payment plans are available by request and must be agreed to in advance.
Pathway to Empowerment with Jai © 2021 Acknowledgement and Release of Liability regarding your progress in Hypnotherapy / Hypnosis / HypnoCoaching with your Hypnotherapist/ Hypnotist / HypnoCoach.
Acknowledgement and Release of Liability: By signing below, you acknowledge that you have reviewed and fully understand the terms and conditions of this Agreement. You have discussed such terms and conditions with your Hypnotherapist / Hypnotist / HypnoCoach, and have had any questions with regard to its terms and conditions answered to your satisfaction. You agree to abide by the terms and conditions of this Agreement and consent to participate in Hypnotherapy / Hypnosis / HypnoCoaching with your Hypnotherapist / Hypnotist / HypnoCoach.
Moreover, in consideration of the benefits to be derived from my services, the receipt whereof is hereby acknowledged, you hereby indemnify and hold harmless, release, remise and forever discharge and covenant not to sue or legally hold liable Pathway to Empowerment with Jai, Jaimis Ulrich, from any and all claims, demands, damages, actions, or causes of action whatsoever related to the hypnosis process.
*The issues presented by you may result in unintended outcomes, including changes in your personal relationships. You should be aware that any decision on the status of a personal relationship is your responsibility. The objective of our time together is not for me to tell you what to do, and how to make your decisions, rather my role is to help guide you, as you discover the answers to live an empowered life that are already within you. Consider me your personal GPS on your pathway to self-discovery.