The Clear Insight — Client Disclosure, Informed Consent & Scope of Practice

California Disclosure Statement

I am a Certified Hypnotherapist. I am not a licensed physician, and my hypnotherapy services are not licensed by the State of California as healing-arts services. The services I provide are complementary or alternative to healing-arts services licensed by the State.

Nature of Services
Hypnotherapy uses hypnosis, focused attention, relaxation, imagery, suggestion, and related self-improvement techniques to support client-selected goals, habits, performance, personal growth, stress management, and general well-being within the practitioner's lawful scope.

Theory of Services
Hypnosis is a state of focused attention and increased responsiveness to suggestion. The work is intended to help clients access their own internal resources, perspectives, habits, and responses in support of self-directed change.

Qualifications
The practitioner is a Certified Hypnotherapist.
Additional education, training, certifications, experience, and professional memberships:

Unless a separate valid California license is expressly identified in writing, the practitioner is not acting as a physician, psychiatrist, psychologist, psychotherapist, marriage and family therapist, clinical social worker, professional clinical counselor, or other state-licensed medical or mental-health professional. The practitioner does not diagnose physical or mental disorders/diseases; prescribe or administer prescription drugs or controlled substances; provide medical advice; or recommend discontinuing or changing medication prescribed by an appropriately licensed practitioner.

• Hypnotherapy is not a substitute for medical care, psychotherapy, psychiatric care, diagnosis, or treatment by an appropriately licensed professional.
• If a concern appears outside the practitioner's competence or lawful scope, services may be declined, paused, or discontinued, and an appropriate licensed professional may be recommended; referral or authorization may be requested when legally or professionally appropriate.

The Clear Insight takes a client-centered, collaborative approach. The practitioner does not impose answers, beliefs, or decisions. Hypnotherapy supports a focused and relaxed state in which clients may explore their own thoughts, perspectives, internal resources, and inner wisdom. You are an active participant; your autonomy, personal values, boundaries, and right to make choices are respected. Suggestions support your stated goals while you remain in control.

You may at any time:

• Ask questions
• Decline a suggestion or technique
• Request another approach
• Pause the session
• Say you are uncomfortable
• End the session

Participation in hypnotherapy is voluntary. You may ask questions, decline a technique, request to stop a session, or discontinue services at any time. Hypnosis does not remove your ability to make choices. You remain responsible for your decisions, actions, and well-being before, during, and after sessions.

Responses to hypnotherapy vary. No particular result, outcome, cure, or improvement is promised or guaranteed. Testimonials, client experiences, case examples, and descriptions of results are individual experiences and not guarantees of another client's results.

The Clear Insight provides professional hypnotherapy services by a Certified Hypnotherapist. Hypnotherapy supports client-selected goals, personal growth, behavioral change, performance, stress management, habits, and general well-being within lawful and professional scope. Hypnotherapy is not medical treatment, psychotherapy, psychiatric treatment, diagnosis, or emergency care. When needs fall outside scope, you may be encouraged to seek an appropriately licensed medical or mental-health professional. The Clear Insight is not an emergency or crisis service; immediate emergencies require appropriate emergency assistance.

The Clear Insight will make reasonable efforts to protect the privacy and confidentiality of information you share in sessions and in connection with services. Confidentiality is not absolute. Information may be disclosed or used when you authorize it, when required by law or valid legal process, when necessary for applicable safety or legal obligations, for legitimate payment, billing, collection, or business administration, or as otherwise permitted or required by law. Because these hypnotherapy services are not state-licensed psychotherapy, you should not assume every legal privilege or confidentiality protection specific to licensed psychotherapy automatically applies. Please ask any questions about privacy.

You are encouraged to raise concerns directly with The Clear Insight when appropriate. If the practitioner holds current certification from the American Council of Hypnotist Examiners (ACHE), concerns regarding alleged ACHE Code of Ethics violations may be submitted according to ACHE procedures.

American Council of Hypnotist Examiners (ACHE)
7183 Navajo Rd., Ste. E, San Diego, CA 92119
Phone: (619) 280-7200
Email: office@hypnotistexaminers.org

The California Department of Consumer Affairs (DCA) provides consumer information and assistance and may direct concerns involving an unregulated business or professional to an appropriate agency when applicable.
DCA Consumer Information Center: (800) 952-5210.

• Provide accurate and reasonably complete information relevant to the appropriateness of hypnotherapy
• Ask questions about anything not understood
• Seek appropriately licensed medical or mental-health care when needed
• Do not use hypnotherapy to delay or avoid appropriate care
• Tell the practitioner if you are uncomfortable, confused, or wish to pause or stop
• Communicate relevant changes or concerns affecting your participation

Fees, payment terms, cancellation and rescheduling, refund, communication, and other business policies may be provided separately in an intake or scheduling agreement or written policy and apply only to the extent provided to and accepted by the client. Please ask any questions before scheduling or beginning services.

By signing below, I acknowledge that I have read and understand this Client Disclosure, Informed Consent & Scope of Practice and voluntarily consent to receive hypnotherapy services from The Clear Insight.