Hypnotherapy Consultation Form & Legal Disclaimer

LEGAL DISCLAIMER
I give my consent to be hypnotised by Luke from Healingenergetics as I understand that by filling out our Consultation form below is an agreeance to the set Terms and Conditions to this legal Disclaimer

I understand that the fee after discussion for this session is non-negotiable and I agree to pay the agreed upon fee regardless of time taken or whether I am able to achieve a Past Life or Soul Regression or not.

I also agree that transfer for the recommended fee, will be no later than 24-48 hours before the treatment, otherwise a cancellation of the session will be contemplated due to lack of effort for the transfer to occur.

I am of legal age and in consideration of my own acceptance as a participant in hypnosis, hypnotherapy, counselling sessions, regression sessions, energy therapies, I for myself, my heirs, executors, administrators and assignee’s do hereby release and discharge Luke from Healingenergetics from all claims of liability, damages, demands, and actions whatsoever in any manner arising from or growing out of my participation.

I also understand that any advice or counselling given, while within the parameters of current modern Hypnotherapeutic Practice, is accepted and/or acted upon entirely at my own risk.In addition,

I understand that, while highly successful, proven, cutting edge techniques are utilized, that No guarantee of any kind whatsoever is implied, promised, or bestowed.

ONLINE THERAPY SESSION
I understand I am responsible for my own technology and connection,  as you will be sent a Video Meeting Link planned in advance. There will be Payment deadlines with a firm cut off date. Client will need to be in a room alone and quiet. I understand that it is Recommended to use headphones during a session and must avoid holding their technology device during the session. 

MEDICAL RELEASE
I understand I am responsible for my own health and well being before, during and after this session.
I confirm that I have no medical condition which prevents me experiencing hypnosis or related activities, and I further understand that this session in no way supersedes any medical or other treatment I may be undergoing from a medical or health practitioner. I also understand and agree that any hypnosis session is purely voluntary on my part.

PERMISSION OF ELECTRONIC RECORD
Furthermore, I give my unequivocal permission to Insert Therapist Name Here to make an electronic record or video of this session as a normal part of participation in hypnosis, hypnotherapy, counselling sessions, and regression sessions. I agree that this electronic recording/video is owned by Healingenergetics.

Please fill out the form below and state your name and the details requested which attests to my unconditional acceptance of all of the above sections: ‘Payment Conditions’, ‘Legal Release,’ ‘Medical Release,’ and ‘Permission of Electronic Record/Video,’ unless otherwise noted or requested thank you.