Client Disclosure Form
Required per California Business & Professions Code Section 2053.6 · Must be signed prior to first session
Practitioner Information
| Practitioner Name | Jithendran Sellamuthu |
| Credential | Certified Master Hypnotist (C.MH.) |
| Certifying Organization | Hypnosis Motivation Institute (HMI) |
| Professional Membership | American Hypnosis Association (AHA) |
| Practice Name | VRishi Immersive Hypnotherapy |
| Location | Redwood City, CA 94061 |
| Phone | +1 858.226.0619 |
| hello@vrishihypno.com |
Nature of Services
Hypnotherapy is a complementary wellness modality. It is not the practice of medicine, psychology, or psychotherapy. I am not a licensed physician, psychologist, or mental health professional. I do not diagnose, treat, or prescribe for any medical or psychological condition.
Hypnotherapy services are provided pursuant to California Business & Professions Code Section 2908, which permits the practice of hypnotherapy by persons who are not licensed healing arts professionals.
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.
Note: A printable PDF version of this disclosure form is provided before your first session and must be signed prior to any hypnotherapy work. Contact hello@vrishihypno.com to request a copy.