Consent form

Code of care
The client will be treated with respect and care at all times.
Disclosure of all information during therapy and consultations remains confidential.

  • The hypnotherapist has a professional obligation to report to relevant authorities any concerns, if they believe the client may be intending to cause harm to themselves, the therapist, or others.
  • A query on the suitability or conflict of therapy with other treatment practitioners may have to be asked occasionally, with client permission.
  • The hypnotherapist has a professional obligation to report to relevant authorities any concerns they believe where the client may intend to harm themselves, the therapist, or others.
  • I have regular supervision as part of my professional practice. I may discuss your case with other qualified hypnotherapists. I will not identify you in these supervision sessions.

A full copy of The Association for Solution Focused Hypnotherapy’s Code of Conduct, Performance, and Ethics is available here.
This complies with that of the CNHC, a Department of Health supported Register on which I am a registered member.
It is advised that you consult your doctor before having complementary therapy, including hypnotherapy. It’s important to note that results may vary from person to person.

Therapy consent

  1. The therapist has fully explained the hypnotherapy plan to my satisfaction.
  2. I understand that I will need to listen to the relaxation CD/online link (not while driving) and to consider the content of the sessions in order to enhance the success of the treatment.
  3. I understand the success of the treatment, in part, is determined by the desire to achieve the changes and the commitment to the format of the sessions.
  4. I accept the fee payable and note the cancellation policy in the terms and conditions.

Respect for the client and therapist will be constantly maintained.

I have read the agreement above and accept the treatment on those terms.

Yes   No


I have confirmed that I have read the GDPR part of the Terms and Conditions and am aware of how my data will be processed and stored:

Yes   No


I am happy for you to contact my GP:

Yes   No


Your name:


Your email: