Hypnotherapy Consent Form

Solution Focused Hypnotherapy Consent Form
Your Details
Name*

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Address*

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Email*
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Phone Number*
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Emergency Contact Details
Name*

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Emergency Contact Phone Number*
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Relationship to you
By signing this form I consent:
- to receiving Solution Focused Hypnotherapy
- to Happy Hypnotherapy contacting me by Email for appointment confirmation and scheduling
- to the Terms and Conditions (which include our contract for working together either online or in person and cancellation policy) and GDPR Privacy Policy
- that in order to provide quality assessment and therapeutic services, Happy Hypnotherapy will collect and record personal information relevant to your situation.
- that I understand that therapy outcomes vary from person to person and that my commitment and engagement in the process is required and as such that outcomes are not guaranteed.
Elaine Neale and Happy Hypnotherapy are based in the UK and governed by UK jurisdiction.

We use a questionnaire called MYCaW® in our service evaluation to evaluate our hypnotherapy service. Meaningful Measures Ltd operates the licence for MYCaW® and collects anonymised and non-identifiable data to create a database of anonymised concerns/symptoms/activities and treatment outcomes for service evaluation purposes. This data collection helps organisations understand people’s needs. Your MYCaW® data will be fully anonymised and sent securely ONLY to Meaningful Measures Ltd, for more information see the website: www.meaningfulmeasures.co.uk
I consent to my anonymised data being shared with Meaningful Measures*

YesNo
I give consent to Happy Hypnotherapy making contact

with me by Phone/Message/SMS regarding my appointment bookings(required)with my GP if necessary for my care, health and wellbeing. This would be discussed with you in advance. (required)via e-Newsletter
I have read and understood this consent form, terms of service, including the cancellation and privacy policies, and confirm my agreement and consent to receive solution focused hypnotherapy on these conditions.
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Solution Focused Hypnotherapy Consent Form

Your Details

Emergency Contact Details