I understand that results vary and that the above name practitioner may not guarantee results. Non-therapeutic hypnotism is not a replacement for medical treatment, psychological or psychiatric services or counseling. I also understand that the Hypnotist does not treat, prescribe for or diagnose any condition. I understand that the practitioner is a facilitator of non-therapeutic hypnotism and is not practicing any other profession that requires a license under the laws of the State it is performed in. I am aware and understand that in some cases it may be necessary for the practitioner to respectfully touch my shoulder(s), arm, 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. I have been advised that I am free to terminate any or all sessions at any time. I have agreed to participate in the session to the best of my ability. I have accurately provided background information as requested by the hypnotist. I understand that confidentially regarding my sessions will be honored between Richard Barker and myself.
Matters regarding your sessions will be kept confidential except in the following circumstances:: You grant me specific permission to release information to a specific individual or agency; child abuse; you are an imminent danger to self or others; or in the case of the subpoena of records. Any information shared is kept confidential. From time to time, I also consult with other colleagues, but in this circumstance, clients are not identified by name.
FEES AND PAYMENTS:
The fee for each session is $600.00 per session. I understand that Richard Barker does not accept any form of insurance or state supplied programs. A deposit of 50% ($300) must be provided immediately to secure a session with the balance being paid on the day of the session. The deposit guarantees a session at anytime within 12 months of its date. Deposits are strictly non refundable.
Your deposit is non refundable or transferable unless a reschedule is made immediately before or on the same day as your original appointment.
REPORTS AND PHONE CALLS:
There is no charge for brief calls. Calls lasting longer than 10 minutes will be charged to the client on a prorated basis. Reports requested by insurance companies, physicians, etc. will not be released without your permission.
Appointments for children under age 18 require written consent from the parent or guardian. For optimum results, it is recommended that parents or guardians not accompany children in the hypnosis session.
CONTACTS OR LENSES:
During hypnosis your eyes will be closed for at least 45 minutes. If your contacts will cause eye irritation, you may want to bring your lens holder and solution so you can remove them just before hypnosis.
I can position you for optimal hearing or speak louder if needed. If you normally wear a hearing aid, please use it as you will have your eyes closed and will not be able to lip-read during a session.
YOU AGREE TO:
- Be an active participant in my hypnotism experience and see myself as a partner in the transformative nature of this process.
- Recognize that my thoughts, feelings, images and actions have a direct effect on the quality of my life.
- Acknowledge that my well being depends directly on how well I care for myself physically,emotionally, intellectually and spiritually.
- Accept that blaming others or myself is totally futile.
- Take responsibility for my experience of life, because I create my life to the best of my ability in the moment, with what I know right now.
- I agree to be on time for my sessions and allow at least 24 hours of advance notice should I need to cancel or reschedule a session.