NOTE: Hypnotist/Hypnotherapist/Practitioner refers to Gavin Rubinstein of GMR Hypnotherapy Ltd. These are all used interchangeably in the following:
I understand that if I have any diagnosed medical conditions e.g. life threatening allergies, mental health conditions, psychosis, personality disorder, a heart condition or epilepsy, then I need to seek my GP’s advice before embarking on Hypnosis/Hypnotherapy or other intervention.
I confirm that I have no medical conditions and have sought advice from my GP confirming I can receive Hypnosis/Hypnotherapy and other interventions such as NLP and Cognitive Behavioural Psychotherapy from Gavin Rubinstein (GMR Hypnotherapy Ltd).
I also confirm that I have accurately provided all background medical information required to the best of my knowledge and have not withheld any necessary medical information from Gavin Rubinstein (GMR Hypnotherapy Ltd).
I have been advised by Gavin Rubinstein (GMR Hypnotherapy Ltd) of the scope of Hypnosis/Hypnotherapy practice and fully understand what he has explained to me. I give my full consent to receiving hypnosis/hypnotherapy in any future session. Gavin Rubinstein (GMR Hypnotherapy Ltd) has discussed with me how he intends to use Hypnosis/Hypnotherapy and the expectations regarding its use.Additionally, Gavin Rubinstein (GMR Hypnotherapy Ltd) has explained the misconceptions regarding Hypnosis/Hypnotherapy.
I understand that outcomes vary from person to person and that the above named practitioner cannot guarantee results.
I understand that Hypnosis/Hypnotherapy is not a replacement for medical treatment, psychological or psychiatric services or for counselling. I also fully understand that the Hypnotist/Hypnotherapist does not treat, prescribe for or diagnose any condition.
I understand that the practitioner is a facilitator of hypnosis/hypnotherapy, NLP and Cognitive Behavioural Psychotherapy.
I am aware and understand that in some cases, it may be necessary for the practitioner to respectfully tap/touch my shoulder(s), hand(s), wrist(s), arm(s) or forehead in order to assist me during a session. I give the practitioner permission and consent to do so in order to help me establish a beneficial state of relaxation/hypnosis or other intervention.
I understand that in Hypnosis/Hypnotherapy, much as in talk therapy, it is possible that I might experience uncomfortable thoughts, emotions, sensations, images or memories. I have been advised that I am free to terminate any or all sessions at any time, albeit I might incur the cancellation fee as outlined below.
I understand that the Hypnotherapy sessions are confidential and confidentiality regarding my sessions will be honoured between Gavin Rubinstein (GMR Hypnotherapy Ltd) and I. This same confidentiality is applied and respected if/when working with minors under the age of 16.
I agree to pay Gavin Rubinstein (GMR Hypnotherapy Ltd) for all services rendered. I understand that all monies are due to be paid and must have cleared in advance of all sessions.
I am aware and fully understand that the practitioner can request up to date medical information regarding my medical history, at any time. This can be requested in the form of a letter from my GP or another fully qualified medical professional. I also understand that by not providing such information when requested, Gavin Rubinstein (GMR Hypnotherapy Ltd) can refuse to proceed with any hypnosis/hypnotherapy or other intervention without providing notice and can also cancel any session or consultation that I have booked, at any time without providing notice.
Fees: Prices can vary depending on the therapy/intervention used and the duration of each session. Prices may be subject to change at any time. The price of my session(s) has been explained to me which I agree to. Each session may last anywhere from 15 minutes to 1 hour in duration and can vary from time to time if necessary. Payment to Gavin Rubinstein (GMR Hypnotherapy Ltd) is due in full and must have cleared at least 48 hours prior to any agreed session date.
Cancellation/Rescheduling: I understand that should I need to cancel or reschedule a session, I am required to provide at least 72 hours notice to Gavin Rubinstein (GMR Hypnotherapy Ltd). Unless cancelled or rescheduled prior to 72 hours notice, I am financially responsible for 75% of the price of the scheduled session fee.
I agree to all sessions with Gavin Rubinstein (GMR Hypnotherapy Ltd) being recorded and kept by Gavin Rubinstein (GMR Hypnotherapy Ltd) for record purposes.
By signing the Client Consultation Form I confirm that I have read, understood and agree to all of the terms and policies listed on that form and I also confirm that I have read, understood and agree to all of the terms and policies listed above and set out at www.gmrhypnotherapy.com