Client Disclosure Form

Nature of Services

VRishi Immersive Hypnotherapy offers three service lanes under California Business & Professions Code § 2908:

Lane 1 — Self-Improvement Hypnosis: Avocational or vocational self-improvement services including relaxation, confidence, habit change, motivation, performance, public speaking, sleep improvement, weight-management support, and personal growth. These services are not medical, psychological, or psychiatric diagnosis or treatment.

Lane 2 — Education & Training: Instruction in self-hypnosis and personal-development techniques, including guided self-hypnosis training, workshops, and coaching in relaxation, stress management, habit change, and performance enhancement. Not medical or psychological treatment.

Lane 3 — Referral-Based Hypnotherapy: Hypnotherapy services for medical or psychological purposes are available only upon referral from a licensed physician, dentist, or psychologist, where applicable. Written referral documentation is required before these services.

I am not a licensed physician, psychologist, psychotherapist, dentist, or psychiatrist. I do not diagnose or treat medical or psychological conditions. Services are alternative or complementary to state-licensed healing arts services and are not licensed by the state of California.

Client Rights

• You may terminate a session at any time.
• You will not be asked to do anything that conflicts with your values.
• All session content is confidential.
• You are always in control during hypnosis.
• Hypnotherapy is voluntary and collaborative.

Acknowledgement

By proceeding with hypnotherapy services, you acknowledge that you have read and understood this disclosure. A signed copy will be provided for your records and retained for a minimum of three years per CA B&P Code 2053.6.