I acknowledge and agree to the following:
I understand this statement serves as being advised by Terri Lee Dotzenroth of Terri Lee Hypnosis the scope of the hypnosis/ hypnotherapy/ coaching and I give my full consent to receiving hypnosis/ hypnotherapy/ coaching sessions by the above practitioner for myself and/or my dependent minors under the age of eighteen. I understand that my results are up to me and that the above practitioner is my guide and it's up to me to do the work. I understand that results vary and that the above practitioner may not guarantee results
I understand that hypnosis/ hypnotherapy/ coaching is not a replacement for medical treatment, psychological or psychiatric services or counselling. I also understand that the Hypnotist/ Hypnotherapist/ Practitioner does not treat, prescribe for or diagnose any condition. I understand that the practitioner does not diagnose any condition or illness. I have accurately provided background information as requested by the hypnotherapist/practitioner.
Integrity
I understand that the practitioner is a facilitator of hypnosis, hypnotherapy, coaching and other helping modalities and is not practicing any other profession that requires a license under the laws of the Province of Alberta.
Informed Consent
I am aware and understand that, in some cases, it may be necessary for the practitioner to respectfully touch my shoulder(s), hand, wrist, or forehead in order to assist me in relaxation. I give the practitioner permission and consent to do so in order to help me establish a beneficial state of hypnosis.
Fees and Financial Arrangements
I understand that all prepaid service fees/sessions are non-refundable. Prepaid service fees/sessions are to be used within one year (12 months) of payment unless otherwise indicated in the program. A session will be deemed as used for less than 24 hours’ notice of cancellation. All digital products and courses are final sale and are non-refundable.
Terminating the Professional Relationship
I am free to terminate any or all sessions at any time, without a refund. I agree to participate in each session to the best of my ability. At the recommendation of my practitioner and in my best interest, I may be transferred to another practitioner.
Confidentiality
I understand that confidentiality regarding my sessions will be honoured between the practitioner and myself. The same confidentiality is respected when working with minors under the age of eighteen.
Except… if the practitioner has reason to believe and does believe that a dependent (child or elder) is being abused (emotionally, physically, sexually, or financially). If the practitioner has reason to believe and does believe that you are doing harm to yourself or others (it must be imminent harm). And except if ordered by a court to release files.