• Cognitive Hypnotherapy Client - Therapist Agreement

    Cognitive Hypnotherapy Client - Therapist Agreement

    @ Holistic Therapy Ealing
  • Agreement

    This agreement details the terms and conditions concerning our work together and is between the Client:

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  • and Kate Kotlarska (the Therapist)

     

    1.     The agreement to work on the issues presented by the Client in no way guarantees a cure. Success of the treatment, in part, is determined by the dedication to achieve the changes and the commitment to the format of the sessions.  Listening to the track every night is an important and essential aspect to the treatment.

     

    2.     Appointments are charged at a rate of £100 per session. Fees are payable via Bank Transfer and payable prior or on the day of the session.

     

    3.     Sessions will be scheduled at the mutual convenience of the Therapist and the Client. Appointments can last 1-1.5 and it is good to have some free time afterwards to be able to process the session.

     

    4.     Contact between sessions may be by email or text, you may email or text the Therapist with important news, or if you are experiencing some difficulties and would like support related to your treatment.  If required, a brief telephone call may be arranged for this purpose and may be requested by email or text.  The Therapist may email or text you if there is something to share in between sessions. 

     

    5.     Behaviour by the Client, which is deemed to be antisocial by the Therapist, will cause the immediate cessation of treatment.

     

    7.     Privacy and confidentiality are essential for building of trust in therapeutic relationship. Confidentiality will be maintained in all but the most exceptional circumstances. These can only include: legal action (criminal or civil court cases where a court order is made demanding disclosure – includes coroner’s courts) and where there is a good cause to believe that not to disclose would cause danger of serious harm to self or others. Most standards of confidentiality applied in professional contexts are based on the Common Law concept of confidentiality where the duty to keep confidence is measured against the concept of ‘greater good’. The sharing of anonymous case histories with supervisors and peer-support groups is not a breach of professional confidentiality. The sharing of open case histories with supervisors and any referring NHS medical practitioner is also not a breach.

     

    8.     Notes of sessions will be kept and are available for the Client to view, but not removed from the Therapist’s premises, at a mutually convenient time and with reasonable notice.

    9.     Sessions may be recorded. Prior to any recording, your agreement will be sought.  Recordings will remain confidential in all but the most exceptional circumstances described in Clause 7 above.

     

    10.     The Client confirms that they are not suffering from any diagnosed psychiatric condition, psychological illness or epilepsy and are not under the supervision of a psychiatrist. By signing below, the client confirms that they have never been diagnosed with any such conditions including schizophrenia, bi-polar disorder, personality disorder, narcolepsy any form of psychotic episode and that any current or previous history of psychiatric or psychological illness or epilepsy has been disclosed on the Therapist’s Client Information Form. I don't offer sessions for drug  or alcohol additction, and will refuse to work with anyone under influence of alcohol or drugs. venthough that hypnosis is safe to conduct while you are pregnant, I don't currently offer hypnotherapy sessions to pregnant ladies, therefore by signing the form the client confirms that she is not pregnant.

     

    11.     The Client confirms that they understand that Hypnotherapy MP3 files provided for the Client by the Therapist for use by the Client in between sessions should not be listened to whilst driving, operating machinery or undertaking any other activity where concentration is required. Any such MP3 file provided is for the Client’s personal use and must not be lent, copied or sold under any circumstances.

     

    12.     Cancellation of an appointment by the client with a notice period of less than 24 hours will be charged at 50% of the agreed fee, at the discretion of the therapist. Any appointment cancelled by the therapist will not be charged. 

     

     

    13.     These Terms are governed by the law of England & Wales and are subject to the exclusive jurisdiction of the Courts of England and Wales.

     

    14.     I consent to the collection and storage of my personal data by the therapist for the purpose of confidential client notes. This data will not be shared with any other party other than in exceptional circumstances as noted in clause 7 above.

  • Questions For questions or concerns, you may get in touch with me through this number: 07899737421. I can also be reached out via email at info@holistictherapyealing.co.uk

  • Consent to Cognitive Hypnotherapy

    @ Holistic Thearpy Ealing
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  • Parental consent - for parents of young people under 18

  • Parent of young person- below 18yo

    Please fill in this section to consent them having a hypnotherapy session. INFORMED CONSENT The purpose of this form is to share some important principles which guide my therapeutic practice, so that your decision to place your child/young person into therapy with me can be based on accurate, informed expectations. Please read this carefully and feel free to ask any questions if you need further clarification. THERAPY Therapy is a process, which relies heavily on building a trusting relationship between the therapist and client. The time that this process takes, for a person to feel ready to open up and for the therapist to understand what the client is struggling with, can vary depending on the individual. It is important that the process is navigated at a speed which feels comfortable and safe for the client. CONFIDENTIALITY Privacy and confidentiality are essential for the building of trust in the therapeutic relationship. Younger people need to feel free to discuss issues that affect them and often this will be about their relationships. Sometimes this will include their relationship with their parent/carer. Conversations will always be confidential unless there is a safeguarding concern. If, at any point, the young person is in danger, either through their own actions or potential actions, or those of others, confidentiality will be broken. DATA PROTECTION I am obliged to collect certain data: name, date of birth, address, GP and number of the parent/carer. I store notes securely and keep them for 7 years (CNHC Guidance) when they will be destroyed. By signing below, you are indicating that you give your permission for your child/youngperson to be in therapy with Kate Kotlarska and that you have read and understood this consent form For clients over 13 years old, please ask them to sign also. .
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