Hypnosis Disclaimer and Acknowledgment Form

Waiver of Liability: The client voluntarily agrees to participate in hypnosis sessions under the direction of Nicole Reyes, CHT, and accepts full responsibility for any and all injury arising from the hypnotherapy sessions.

Therapy Disclaimer: Nicole Reyes is a licensed mental health therapist with a Master of Arts in Counseling Psychology. HOWEVER, she is not operating under her therapy license when providing hypnosis services, and under no circumstances is she providing mental health therapy or mental health therapy services during the hypnosis sessions. If you have been a hypnosis client in any capacity, you cannot be seen by Nicole Reyes as a therapy client in the future. It is advised to seek help from another licensed provider for any mental health diagnosis.

Guarantee and Refund Policy: No warranty or guarantee is given, expressed or implied, for satisfactory results from hypnotherapy sessions, as it is impossible to guarantee human behavior or compliance. Therefore, no refunds for services are given. The client understands that change is their responsibility. The hypnotherapist is considered a guide or facilitator in the process.

Methods Used: Specific techniques may include Body Relaxation/Progressive Muscle Relaxation, Guided Meditation, Regression, Behavior Modification, and Guided/Visual Imagery. The client understands that these modalities are not substitutes for regular medical care and has been advised to consult with their medical doctor or health care practitioner for treatment of any old, new, or existing medical conditions.

Education and Training: Nicole Reyes was trained by Leah Agami, CHT, and certified by the International Certification Board of Coaches and Hypnotists (ICBCH). Nicole Reyes holds the title of Certified Clinical Hypnotherapist (CCHT) due to also holding a clinical mental health therapist license in addition to hypnotherapy training.

Fees and Payment Policy: Payment is due in full at the time of scheduling service. Session fees are subject to review and change. Twenty-four (24) hour cancellation notice is required, otherwise the client will be billed for the session. If cancelled before the 24-hour notice timeframe, credit for rescheduling a missed or unused scheduled pre-paid package session will be honored for up to 30 days from the last scheduled session appointment.

Minors: Appointments for children under 18 years of age require written consent from a parent or guardian, who must accompany them at each visit.

Right to Refuse Service Statement: Elara Integrated Wellness, LLC reserves the right to refuse service to anyone, at any time, for any reason.

Final Acknowledgment: My signature below signifies that I have read the above statements and fully understand and accept the information described above, and agree to participate in hypnosis sessions.