Hypnotherapy Consent template

1. Nature of Hypnotherapy

• Hypnotherapy uses guided relaxation and focused attention to support behaviour change, stress reduction, or symptom relief. I remain aware and in control throughout, and can end a session at any time.

2. Risks and Suitability

• Hypnotherapy is generally safe, though it may occasionally bring up unexpected emotions or memories. I confirm I have disclosed any history of psychosis, epilepsy, or serious mental illness, as these may affect suitability.

3. No Guaranteed Outcome

• I understand that hypnotherapy is not a medical treatment, does not replace advice from my GP, and that results vary between individuals with no specific outcome guaranteed.

4. Confidentiality and Data Protection

• Information shared is confidential and processed under the UK GDPR and Data Protection Act 2018, save where disclosure is required by law or to prevent harm.

5. Cancellation Policy

• I agree to give at least 24 hours' notice to cancel or reschedule; late cancellations may incur a fee.

Client Information

• Full NameText
• Date of BirthDate
• Relevant Medical HistoryText
• Phone / EmailText

Practitioner Information

• Practitioner NameText
• Registration No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Practitioner SignatureSignature
• Date signed (practitioner)Date

• By signing below, I confirm I have disclosed relevant health information and voluntarily consent to hypnotherapy.