Hypnotherapy Booking

Please complete the form below and Vanessa will be in touch with you

Before we can book you in for Hypnotherapy... We need some details

Before your consultation, where Vanessa will book you in for your Hypnotherapy session, we need some information from you please.

This is so we comply with all the latest safeguarding and legislation involved with the practice of Hypnotherapy and will be useful to use as reference during your consultation.

The information we ask for is treated as private and sensitive, and is used in accordance with our Data Protection Policy.

Please complete & submit the form below - Thank you

Want to discuss this further & to book?

Please get in touch if you’d like to find out more about this service or enquire about making a booking.

Please Read Carefully & Note the Following:

 

  1. I have been advised by Vanessa White the scope of the therapies she provides and give my full consent to receiving therapy sessions from Vanessa White.  I understand that results vary from person to person, and the agreement by Vanessa White to work on the issues or problems presented by me, using whatever model or models are appropriate to my situation, in no way implies or guarantees a ‘cure’ of the said issues or problems. 
  1. It has been explained to me by Vanessa White and I understand that hypnotherapy is a collaborative process, and the degree of progress is dependent on my active participation and engagement in the process.  I understand that there are no guarantees offered and that success depends on my active participation and motivation.  I understand that I am paying for Vanessa Whites time and not for a guarantee of success.
  1. I understand that Hypnotherapy, or any other therapy provided by Vanessa White is not a replacement for medical treatment, psychological or psychiatric services or the appropriate counselling.  I also understand that Vanessa does not treat, prescribe for, or diagnose any medical or mental health condition. 
  1. I declare that, if advised prior to any session with Vanessa White to seek medical approval, I have consulted with my General Practitioner and/or Hospital Consultant and gained the appropriate medical approval for working with Vanessa White. 
  1. The number of sessions are discussed and agreed at the start and I agree to pay for any session prior to it taking place.
  1. I understand and agree that my therapy sessions will take place in Vanessa Whites therapy room or online as discussed. 
  1. I have been advised that I am free to terminate any or all sessions at any time. I have agreed to participate in each session to the best of my ability, and that contact between sessions will be strictly limited to telephone, email or letter. 
  1. I have accurately and truthfully answered the questions on this form and provided background information as requested by Vanessa White 
  1. I understand that any mp3 download/CD is provided for me at Vanessa Whites discretion. I agree that any such mp3 download or CD is for my personal use only and that it is not to be lent, copied or sold under any circumstances. 
  1. As a GHR member    I am bound by GHR’s Code of Ethics and Practice and its Complaints Procedure, you can request a copy of these electronically.
  1. Confidentiality is paramount and will be maintained in all but the most exceptional circumstances. I agree that these can include: legal action (criminal or civil court cases where a court order is made demanding disclosure, including coroners’ courts); child abuse; if I am an imminent danger to myself or others; and where there is good cause to believe that not to disclose would cause danger of serious harm to others. Most standards of confidentiality applied in professional contexts are based on the Common Law concept of confidentiality where the duty to keep confidence is measured against the concept of ‘greater good’. The sharing of anonymous case histories with supervisors and peer-support groups is not a breach of professional confidentiality. The sharing of open case histories with supervisors and any referring NHS medical practitioner is also not a breach. I would attempt to discuss this fully with the client first.

 

PLEASE NOTE:  Vanessa White reserves your sessions for you and it is the policy to charge the full fee for cancellations received with less than 48  hours’ notice, or non-attendance. By signing below, you agree to this. If for any reason Vanessa White needs to cancel as a session no charge will be issued.