$20,494 to $197

Please Complete The Following Release Form PRIOR To Your Appointment

In order to maximize the use of time of the appointment, please try and have the information below completed and signed before your appointment.

Darren Johnson C.Ht. - Clinical Hypnotherapist 

089 933 5267 - darrenjohnsonservices@gmail.com


STRICTLY CONFIDENTIAL 

PERSONAL DETAILS

HEALTH

FROM THE LIST BELOW CHECK THE AREAS THAT CONCERN YOU

Consent

Darren Johnson of Darren Johnson Hypnosis offers which includes hypnosis and can include regression techniques. 

Hypnosis is entirely natural, safe, and relaxing. With Hypnosis clients remain conscious and in complete control throughout but will feel a strong sense of relaxation. 

Hypnosis alone does not offer any guarantee of success. The client must want change and be open and motivated. The client must be willing to fully participate in the session and to implement the recommendations of the hypnotherapist and to listen to the recording(s) given to reinforce the session(s).

I understand that Darren is not a licensed physician, psychologist, or medical practitioner and the information, techniques, methods, recommendations by Darren are not intended to substitute for diagnosis and care by a qualified physician, nor to encourage the treatment of any illness by persons not recognizably qualified. If you use hypnosis and are under medical care for ANY condition, DO NOT make any adjustments to any prescribed medication without the approval of your doctor. If in any doubt, you should contact your physician.

I give Darren full permission to make audio recordings of her voice during the session(s). I understand that if a recording (or recordings) are made during or after my session(s), Darren holds full copyright over any forms of media that may be produced and distributed to me.

I hereby grant permission to Darren to respectfully lift my arm, touch my shoulder, or rock my head during the course of my hypnotherapy session(s) in order to facilitate the deepening process. 

I consent that Darren release information to a specified individual or agency if it has been determined that a child or elder is at risk of or is currently being abused; or if I, as a client, am in imminent danger to myself or others. 

I hereby give Darren full permission to hypnotize me and to use Hypnotherapy in the knowledge that I do so at my own risk. I accept that while hypnosis has a high success rate, Darren does not guarantee any results and the success of the session(s) depends greatly on my own ability and desire to affect change.

I release Darren from any liability or claims concerning my mental and/or physical well-being during or following the treatment that has been outlined and agreed upon by filling out this form. 

I understand that if I am epileptic or suffer from a psychotic illness it is not generally recommended that I undergo hypnotherapy. I hereby agree that by signing this form that I do not currently suffer from these disorders. 

I understand that Darren Johnson Hypnosis does not offer refunds for unused/missed sessions in packages and that all sessions are to be used within 6 months. 

I can confirm that I have read the above and understand the process of hypnotherapy and accept these terms and conditions.



Clear

06/15/2024

*** Please phone/text/email at least twenty-four hours in advance in the unlikely event that you need to reschedule your appointment. Failure to do so wastes time, and you will be charged the full fee for the missed appointment.