Subject: Community Service Self-Improvement Program

I, the undersigned, acknowledge that I understand and agree to the following:

I understand that the hypnotherapy services I am receiving are provided at no charge as part of the practitioner’s supervised community service program at a nationally accredited college of hypnotherapy.

I understand that these services are for vocational and avocational self-improvement purposes and are not a substitute for licensed medical, psychological, psychiatric, or dental treatment.

I understand that the program of conditioning offered will include an undetermined number of private sessions, depending on my needs and progress. Each session is approximately 50 to 90 minutes in duration.

I agree to give 24 hours notice for all cancellations or changes of scheduled appointments. I understand that failure to provide notice may result in termination of services.

It is a common practice for the hypnotherapist to record the hypnosis portion (only) of sessions and share that recording with the client for reinforcement between sessions. I consent to this practice.

I understand that sessions are conducted via Zoom and require a quiet, interruption-free environment and reliable internet connection.

I understand that services are by mutual consent and may be discontinued by either party at any time.