Informed Consent for Hypnotherapy Services

Practitioner: Priscilla LOWE, acting on behalf of VIETRIS LLC
Address: 30 N Gould St Ste, Sheridan, WY 82801
Email / Phone: freeyourselftobe@gmail.com / +1(213)-464-2149

1. Nature of Services: I understand that hypnotherapy is a non-medical, non-psychotherapeutic service for personal growth, behavioral change, and well-being. Sessions may be conducted in person or remotely, as proposed by the practitioner. The practitioner may use either standard hypnotherapy techniques or the Vietris technique, depending on what is deemed most appropriate. Hypnotherapy does not diagnose, treat, or cure any medical or psychological condition.

2. Voluntary Participation: Participation is voluntary, and I may stop or pause sessions at any time.

3. Risks and Benefits: I understand that outcomes cannot be guaranteed. Sessions may involve emotional responses, memory recall, or changes in perception, and I accept responsibility for my reactions and choices.

4. Confidentiality: All information shared is confidential, except as required by law.

5. Remote Sessions: I understand the risks of video communication, including privacy and technical issues, and consent to receive services online if offered remotely.

6. Multi-Session Consent: By signing below, I consent to multiple hypnotherapy sessions. Each session may be conducted in person or online, and may use either standard hypnotherapy or the Vietris technique, depending on the practitioner’s assessment.

7. Consent: By signing below, I confirm that I have read and understood this document, consent to hypnotherapy sessions as proposed by the practitioner, in person or online, for multiple sessions, and all my questions have been answered.

Practitioner: Priscilla LOWE, acting on behalf of VIETRIS LLC
Contact: freeyourselftobe@gmail.com / +1(213)-464-2149

Practitioner signature to be completed after client submission.