Consent and Intake

Consent for Treatment

I understand that my practitioner is not qualified to give legal, financial or medical advice.  I understand that hypnosis is an altered state of mind and I know of no medical, physical or emotional condition that would adversely affect me being hypnotized.  I agree that I am solely responsible for any action that I take or refrain from taking in connection with the topics discussed during our session.

I understand that this treatment is provided at my request and I agree to undergo the said treatment at my own risk.  I have been informed of the nature and purpose of said treatment.  I acknowledge that my personal information will be collected, held and managed under the guidelines of the Personal Information Protection Act of British Columbia and will not be disclosed without prior approval.  I understand that communication between myself and the practitioner is confidential except for any information that pertains to abuse or potential abuse of a minor or intended damage to person or property.  I understand that the practitioner is legally responsible to report to the proper authorities upon such disclosure(s).