Please write your name in the first space provided, then sign and write the date below to indicate that you understand what you have read.
I,___________________________________, agree to engage in the process of non-therapeutic hypnosis. I understand that I will have all the choices at all times and can start or end the process at anytime, even during my session.
Declaration & Disclaimer
My services as a coach and Hypnotist rendered are non-therapeutic. Best defined as the learning of the working of the mind to induce, relaxation, positive thinking, create commitment to behavior change and to learn the techniques of self-hypnosis to create awareness and self-control over emotional and physical experiences. My services ARE NOT a form of health care or psychotherapy and ARE NOT eligible for healthcare benefit claims.
Hypnotherapy is not a substitute for professional medical care as prescribed by a qualified medical doctor.
The methods of hypnosis include relaxation, breath work, creative visualization, positive suggestions, positive affirmations, self-awareness development and other techniques and may produce emotional and physical responses. Incase of any form of concerns, fears, unease or discomfort please inform me prior to a session.
I agree to inform my hypnotist of any adverse feelings or experiences related to this process, at the time of my awareness of them.
I am over age 18, and consent to hypnosis services offered by Alexander Douglas Gacheru