Consent Form

Declaration of Consent & Therapy Agreement

Internet based consultations. All relevant aftercare guidance or consultation procedures, in line with training guidelines, are to be declared too and consented by the client with evidence recorded in a durable medium.


I am the Client: _______________________________________________________________________

I am the Parent / Guardian of: ___________________________________________________________

Doctors Name and Address: _____________________________________________________________

Signed:__________________________   Date:_____________________

Therapy Sessions

Data protection and client confidentiality is paramount. Therapy and sessions are confidential and will not be shared or discussed with third parties unless requested by you in writing. Information will not be held electronically but in paper form, accessible only to myself and destroyed after 6 months, within the legal requirement. All Hypnosis is Self-Hypnosis. At the start of a session I always give you a simple method where you can take control just in case we lost contact.

I will continue to give one on one, ‘face to face’, therapy, in a carefully controlled environment. We no longer have the luxury to be ‘face to face’ but can still get positive results. If we look at the plus side, SKYPE enables us to reduce possible embarrassment, which in many cases makes it easier to face your problems and get positive resolutions. Using SKYPE of course, it doesn’t matter where either you or myself are in the World, we can still meet ‘face to face’ on our computers.

Location of Sessions: via SKYPE
Duration of sessions from 50 to 60 minutes. Further sessions are held on a weekly basis.
Time and day by agreement.
Normally 1 session will produce the desired result for you, If more sessions are needed we will discuss and agree this before commencement.

Session: £80 or €100
Each session will be paid, in advance, to PayPal,
If it is decided that a final session is not needed you will of course be reimbursed for that session.

If it is necessary to re-arrange or cancel a therapy session, the therapist should be notified as soon as possible, within 24 hours. If a session is cancelled with less than 24 hours notice the full fee will be charged. If the therapist misses a session it will be added onto the end date.
If any advanced payments are received and the therapy ends before the finish date these payments will be reimbursed to source.