DISCLOSURE OF SERVICES
In recognition that millions
of Californians receive a substantial volume of healthcare services from
complementary and alternative health care practitioners, California Law allows
access by California residents to complementary and alternative healthcare
practitioners who are not providing services that require medical training and
credentials. The following
disclosure is provided in compliance with Section 2053.6 of the California Business
and Professions Code.
The purpose of a program of
hypnotherapy is for vocational and avocational self-improvement (Business and
Professions Code 2908) and as alternative or complementary treatment to healing
arts services licensed by the state.
A hypnotherapist is not a licensed physician or psychologist and
hypnotherapy services are not licensed by the State of California. Services are non-diagnostic and do not
include the practice of medicine, neither should they be considered as a
substitute for licensed medical or psychological services or procedures. .
Hypnosis works with the power
of the subconscious mind to change habits and behaviors. The subconscious mind is considered to
be the source or root of many of our behaviors, emotions, attitudes and
motivations. Hypnosis is believed
to be a powerful tool for accessing the subconscious mind and creating
improvements in our lives.
Services consist of a program
of conditioning, including an undetermined number of private sessions,
depending on the client’s individual needs. The hypnotist will to the best of his or her ability
endeavor to accomplish the objectives of the client’s sessions. While hypnosis may be an effective
technique for many purposes, the effectiveness may vary from individual to
individual, and no specific results or progress can be promised or guaranteed.
During hypnotherapy sessions,
clients remain completely aware of everything that is going on. In fact, many people experience a
hyper-awareness where sensations are perceived enriched and vivid. The ability to visualize or imagine is
enhanced. Deep relaxation is
common. Many describe the hypnotic
state as a complete and total escape from physical tension and emotional
stress, while remaining completely alert.
The use of hypnosis could
elicit memories of past events which may or may not be literally true. It is possible that events under
hypnosis will be distorted or misconstrued. Memories or images evoked under hypnosis are not necessarily
accurate and may be a construction or a composite of memories. Without corroborating information, it
is not possible to determine whether a specific memory is true or false, even
if it seems true to the client.
While it is the practice of Hypnotherapists
to keep information confidential, information revealed in hypnotherapy is not
subject to the psychotherapist-patient privilege. A court may order disclosure of information learned in
I have received a copy of this disclosure and understand
the information described above. I have also read a biography of the Hypnotherapists education, training, experience and other
qualifications regarding the services to be provided.
Client Name (please print):
Client Signature: ________________________________________________________