I understand that the results obtained through Hypnosis vary with each individual and that no specific results can be guaranteed. Certain medications and social habits may decrease the beneficial effects of Hypnosis. These include the use and abuse of alcohol, tobacco, steroids, painkillers, narcotics, stimulants, antidepressants, psycho pharmaceuticals and illegal drugs.
I understand that Hypnosis carries the inherent risk of uncovering unpleasant memories, which could cause intense emotional discomfort. By signing this consent form, I hereby signify that I accept that risk without reservation.
I understand that Hypnosis is not a replacement for medical or psychological diagnosis and treatment or any type of mental health counseling.
I understand that the Hypnotist does not diagnose ailments, prescribe treatments or treat any physical or mental condition. Nothing said or done by the Hypnotist will be construed as such. The services provided do not include the practice of medicine. These services are non-diagnostic and are complimentary to the healing arts services that are licensed by the State of North Carolina.
I understand that the Hypnotist is a facilitator of Hypnosis and is not practicing any other profession that requires a license under the laws of the State of North Carolina.
I understand that in some circumstances it may be necessary for the Hypnotist to respectfully touch me on the hand, wrist, arm, shoulder or forehead as a means of helping me establish a beneficial state of relaxation. I hereby consent to such touching by the Hypnotist.
In signing this consent, I give permission that sessions may be audio taped for my protection. Said audio is the personal property of Transformational Hypnosis and will not be heard by any other person without my written consent. I will receive a copy of the audio file.
I acknowledge that I am free to terminate any or all sessions at any time, and that I have freely consented to participate in each session.
I understand the content of this form and all Hypnosis sessions are completely confidential. Confidentiality is also respected when the client is under eighteen (18) years of age.
The Hypnotist utilizes interviews, discussion and Hypnotic methods dealing with issues whenever appropriate, with the goal to achieve effective and lasting results.
I enter into Hypnosis willingly and out of my own desire for self-exploration, Self-Help and/or changing unwanted habits. I certify that I am requesting Hypnosis services on my own initiative and realize that Michael C. Ferrin or Beverley A. Ferrin are not a psychologist, medical doctor or licensed mental health care physician or provider. I hold Michael C. Ferrin, Beverley A. Ferrin, Transformational Hypnosis and all employees associated with said corporation exempt from all litigation that might arise.