Consent Form - Hypnosis

Please fill out the following consent form prior to first session 
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Have you ever had a serious accident, injury or illness?
Are you under doctor's care?
Are you presently taking any drugs or medication?

Terms & Conditions:

I acknowledge that Hypnosis is not a medical procedure nor is it a practise of medicine and that it consists of voluntary submission of an individual to a series of carefully controlled suggestions, thereby increasing suggestibility of submission to achieve specific therapeutic results. I also acknowledge that success and failure of this hypnosis depends upon many unknown factors and it is impossible to ascertain what responses I will exhibit during my hypnotic sessions and there is no guarantee in achieving the specific goals.

 

I, hereby release and forever indemnify Ms. Karen Armstrong or anyone working for her or assisting her in her practise or organizations associated with her, and shall not make any claim against the above referred individuals or organizations for any injuries or other damages I suffer arising from the hypnotic sessions, instructions, programs, teaching of relaxation, assistance in specific goal achievements or any other such activities in which I participate or follow their advice, even if such damages or injuries arise out of their negligence.

 

I also understand that for all legal purposes, the services provided by Karen Armstrong will be considered to be provided in Alberta, Canada and that the Courts of Alberta shall have exclusive jurisdiction to hear any complaint, demand, proceeding or cause of action, whatsoever arising from or in connection with the hypnosis services or from any other aspect of the professional relationship between myself and Karen Armstrong.

 

All information will be treated as confidential and will not be released to anybody, except upon your written request.

 

Please note: For clients under 18 years old, a parent or legal guardian must sign

Thanks for submitting!