511 Main Street, Sturbridge, MA
Consent Form for Three (3) Session Personalized Program
Fees: Fees for services are prepaid through website DebKHypnosis.com to confirm your commitment to your appointments, listening to recording and fully participating in all aspects for reaching your goal. These are non-refundable sessions that may or may not include recordings, books and written material.
Cancellation Policy: Your appointment time is reserved exclusively for you. Please arrive promptly to obtain your full session. If you must cancel or reschedule, we require a 24-hour notice, (I understand emergencies, being sick or weather may play in cancellation, please call as soon as possible) otherwise you may lose this session.
Confidentiality: All hypnosis sessions are confidential. We will not release any information to anyone without written authorization from you. The recording is saved with your first name and last initial.
Notice: Hypnosis is a natural and safe, self-help process. Hypnosis is not the practice of medicine nor psychotherapy. The hypnosis service provides education and self-improvement purposes and are not intended for diagnosis or treatment of any medical or psychological condition. If you have an ongoing medical illness, mental disability, or mental illness, please continue with your doctor services. In some cases, a doctor referral will be needed.
Certifications: We offer hypnosis services in accordance with the Code of Ethics and Standards prescribed by National Guild of Hypnotists, Inc. If you should have a complaint which we have not resolved to your satisfaction please feel free to contact the National Guild of Hypnotist, Inc. at PO. Box 308, Merrimack, NH 03054. Phone (603) 429-9438. Email firstname.lastname@example.org. My Certification number is #45870 Debra Kizilcan.
Recordings: Recordings of actual hypnosis sessions may take place, in which I can record on your phone device, or record on my computer which I will send to you via email to listen to for reinforcement. In some cases, I may be able to burn a CD. These recordings are to be listened to when you are in a relaxing situation and NOT LISTENED TO WHILE DRIVING OR DISTRACTED.
Client Consent and Release: I am of legal age and in consideration of my acceptance as participant in hypnosis and EFT (tapping sessions), and do herby release claims of damages, copyright, demands or actions whatsoever in any manner arising from my participation. Further, I understand that audio recordings are made during some sessions are for my personal use only and Deb K Hypnosis, retains the copyright of these recordings.