• Client Disclosure and Consent for Hypnotherapy Services

  • The undersigned ("Client") acknowledges that he or she has been informed of the following information:
  • Putnam Enterprises, LLC, through its hypnotherapist, Rebekka Putnam, ("Hypnotherapist") agrees to provide professional services in accordance with acquired training and experience giving undivided attention during scheduled consultations to facilitate Client's benefits. Hypnotherapist's work is Client-centered. Services provided utilize induction of hypnosis, and methods and principles used to help clients discover their inner creative abilities to develop positive thinking and feeling and to transform undesirable habits and behavior patterns. Therapeutic goals are to achieve freedom from restrictive thought and belief systems, to assist in solving personal problems, developing motivation, and achieving goals. Client may be taught the use of self-hypnotic techniques to assist in achieving goals and resolving issues that have been mutually agreed upon by Client and Hypnotherapist.
  • Hypnosis is not a state of sleep, but is a natural state of mind that can produce extraordinary levels of relaxation of mind, body and emotions. The principles and theories upon which hypnotherapy is based are accessing and utilizing the power of one's inner resources. Hypnosis can transcend the critical, analytical level of mind, and facilitate the acceptance of suggestions, directions and instructions desired by the Client. The therapeutic use of Hypnosis can also elicit information and insights from the inner mind. The hypnotherapist utilizes interviews, discussion and hypnotic methods dealing with underlying issues whenever appropriate, with the goal to achieve effective and lasting results.
  • Services to be provided do not include the practice of medicine, as Hypnotherapist is not a licensed physician. These services are non-diagnostic, and are complementary to the healing arts services that are licensed by the state. The California State Legislature has determined that state licensing may not be conferred upon an occupational group for purposes of status or prestige. The primary purpose of licensing laws for legally defined Healing Arts and Mental Health professionals is to protect public health and safety. Accordingly, Hypnotherapists are not issued licenses by any State Governmental Agency to engage in their professional services.
  • While self-hypnosis and guided hypnosis audios have many beneficial effects, they are not a substitute for appropriate medical attention, and are not intended to diagnose, treat, cure, or prevent any disease or illness. Never listen to hypnosis audios while driving a car, operating machinery or any other unsafe or potentially harmful activity. Self-hypnosis and guided imagery are not appropriate for everyone. Those who should avoid them include the following: epileptics or anyone prone to seizures; anyone who wears a pacemaker; anyone under the age of 18 (except with parental consent) and those who are photosensitive. Also, never listen to self-hypnosis or guided hypnosis recordings when under the influence of alcohol or drugs. If you are on medication, consult a physician before listening to audios.
  • Hypnotherapist acquired the education, training, experience, and qualifications set forth by the American Council of Hypnotist Examiners ("ACHE"). For complaints not resolved by Hypnotherapist, contact ACHE at hypnotistexaminers@gmail.com. Any disputes involving any services or billings shall be resolved by binding arbitration before an agreed arbitrator of the client and hypnotherapist, and failing agreement, appointed by the Santa Barbara County Superior Court's Presiding Judge. Arbitrations should be conducted in accordance with California's Code of Civil Procedure, Section 1280 et seq.
  • I, acknowledge that I have been advised of the foregoing information, and that I have been offered a copy of this Disclosure and Consent form.
  • Date
     - -
  •  
  • Should be Empty: