As a client, you will receive hard copies of the following polices to sign. So that you can refer to them easily, I have made them available to you here for your convenience.
You can find policies here which you can download for your records, or download to electronically sign and send back to me. All clients will need to have these policies signed and submitted before treatment can begin.
If you don’t already have a copy of Adobe Reader, you can download it here. Then, simply open the policies and select ‘Fill & Sign’ from the right hand side. You will then be able to enter your initials and signature as appropriate.
Sensorium Hypnosis Policies
Education & Training
I am a certified Hypnotist through the Nation Guild of Hypnotists. I am registered through the WA State Department of Health (HP 60638443). I have an MS in Rehabilitation Counseling and have worked in the areas of mental health and physical rehab. I do not diagnose medical or mental health conditions and therefore do not provide advice regarding prescription medications of any kind.
Confidentiality and Disclosure Laws
Client records are kept confidential and maintained in compliance with WA State Department of Health guidelines. However, there are a few circumstances in which client information must be shared with the appropriate authorities:
- If you are involved in a civil or criminal lawsuit, a judge may request records be turned over to the court;
- If statements are made regarding abuse or neglect of a child, elderly person or disabled person;
- If statements are made regarding self-harm or harm to others.
About Your Treatment
Your treatment goals are of the utmost importance to me. The sessions scheduled represent a mutual investment of time, energy, focus and commitment. In order to experience positive, long-lasting changes in the way you think and behave, weekly sessions are essential and highly recommended for the first 4 to 8 weeks. Weekly repetition and practice of new skills and tools will facilitate proficiency in handling a wide array of life stressors. Skipping sessions, especially early on, promotes falling back into old habits and thus, delays your progress; it also impedes the cumulative effect of our weekly work together. After this 4 to 8-week time period, bi-monthly sessions may be helpful for maintenance.
Rates & Payment of Services
I understand Sensorium Hypnosis rates have been established as follows:
- Introductory Session (first session w/ assessment paid by all first-time clients planning to participate in ongoing weekly sessions. Rate applies to adults and minors.): $125
- Standard Hypnosis Sessions (all other weekly consecutive sessions): $80
(** Please note rate increase to $90/session beginning September 1, 2019).
- Single Past Life Regression Therapy session: $150
(** Please note rate increase to $175 per session effective September 1, 2019).
- Mediumship: $150
Spiritual Cleansing of Home/Business: $175 (Snohomish County) ; $250 (King, Skagit); $350 (Whatcom); ** Other counties upon request **
Effective, September 1, 2019, standard consecutive hypnosis session prices will increase to $90 per session. Introductory sessions will remain at the current rate of $125. Single session Past Life Regression Therapy will increase to $175. This increase represents practitioner investment in additional training and overall time commitment to each client (75+ minutes of session time, maintenance of detailed case notes, phone calls/texts between sessions, rescheduling/adjustments to sessions to accommodate clients, etc.).
The Below statements will be initialed for the hard-copy. This is simply to show you the policy up front.
I understand medical insurance does not cover Hypnotherapy and that payments may be submitted via cash, check or online through PayPal. Checks can be made out to Sensorium Hypnosis.
I understand my first session (Introductory Session) must be prepaid online at the time of scheduling, or within 72 hours of my first session, in order to reserve my time/space. I understand this fee is non-refundable.
I understand if I am a new client (I have participated only in an Introductory Session), I must prepay 3 sessions in advance online to secure my future session times. I understand it is my responsibility to text or call my hypnotherapist to preschedule these weekly sessions, if they have not been scheduled in person following my first session. I understand these sessions must be utilized within 30 days of payment and are non-refundable.
I understand a minimum of 24-hour advanced notice is required for all session cancelations. If I cancel with less than 24-hour notice or “no show,” I understand I will be charged 100% of my session fee. I understand this fee with be due within 48 hours of a missed session. In the case of prepayment, I understand this money will not be refunded.
I understand if I cancel 2 sessions within a 30-day time period (even if within a 24-hour time period), I will need to prepay for all future sessions. I understand the minimum amount of sessions I can purchase is three (3) and must be utilized within a 30-day time period. I understand these fees are non-refundable.
I understand prepayment of 3 sessions must be utilized within a 30-day time period; prepayment of 6 sessions must be utilized within a 60-day time period. Any unused portion of these payments will not be refunded.
Session Structure, Policies & Protocol
I understand that my practitioner is fully committed to my success and is therefore setting aside more than the industry standard for my session times (industry standard is 30-60 minutes per session). Further, I understand that my practitioner caps the number of clients she sees each day to ensure the efficacy of her work, as well as her complete focus of energy and skills.
I understand that sessions are typically 75-90 minutes in length. If I am late, I agree to a shortened session so as not to interrupt the flow of other scheduled sessions.
I understand that my practitioner may integrate additional tools into my treatment plan, such as energy and spiritual work, to further promote healing, as requested/as appropriate. I understand my practitioner is not advocating/endorsing any specific religious ideology, doctrine, creed, etc. and that my own beliefs will be honored and respected.
I understand the practice of hypnosis, along with other integrated modalities, may involve light touch of head, hands/arms, feet, etc. If I am uncomfortable with this, due to past trauma or for any other reason, I will communicate this to my practitioner who will modify her techniques to accommodate me.
I understand that for purposes of privacy, confidentiality and focus, no other person, including minors, may be present during your sessions. I also understand that sessions may not be recorded using visual or audio equipment; however, the details of my session will be captured in case notes to assist my practitioner with continuity of treatment/goals and in compliance with the WA State Department of Health requirements.
I understand my Hypnotherapist does not diagnose or treat psychiatric disorders and therefore does not offer any advice/opinions regarding psychotherapy services, psychotropic medication management or any other mental health related service. I understand it is my responsibility to advise any other mental health practitioners of my participation in Hypnotherapy services.
I understand I must sign a release of information, if I would like my any other health & wellness practitioner to be able to discuss my treatment/access my records.
I understand that hypnotherapy is not a crisis-oriented service; therefore, if I am feeling suicidal or unsafe in any way, I will call “911” or check in to an emergency medical center for further evaluation.
I understand if I disclose to my hypnotherapist that I am currently the victim of domestic violence or have personally participated in the abuse/neglect of minors or any other vulnerable population under my care, legally this must be reported to the appropriate authorities.
I understand this is a drug and alcohol-free environment and will not use such substances within 4 hours of scheduled visits (except for medically prescribed marijuana). I understand such substances may impede my ability to focus, concentrate and process new information – and may ultimately prevent treatment progress.
In order to respect the privacy and scheduled session times of other clients, I agree to wait until my scheduled session time to enter the premises.
PERKS FOR REGULAR/ONGOING HYPNOSIS CLIENTS: I understand that if I am a client who has participated in and paid for at least 4 consecutive weekly hypnosis sessions, I can request one Past Life Regression Therapy session at the standard hypnosis session rate of $80/session.
(** Advanced notice of 1-2 weeks must be provided to practitioner for Past Life Regression session, as additional time must be reserved. **)
WEIGHT LOSS CLIENTS ONLY: I understand that hypnosis is to be used in conjunction with regular exercise, nutritional adjustments and medical care. Utilizing a gym and in some cases even a personal trainer, nutritionist and/or any number of medical/health & wellness professionals (mainstream and/or non-mainstream) is highly recommended. Certain medical conditions may impact your ability to lose weight; therefore, please consult a medical practitioner if you are experiencing unexplainable weight loss challenges or weight gain, even with significant lifestyle adjustments. Also, certain psychotropic medications used to treat depression, anxiety, various mood disorders, etc., may seriously impede your ability to lose weight, so please be proactive in discussing this side effect with your prescriber.
FOR PARENTS SEEKING TREATMENT OF MINORS (under 18 years of age) ONLY: I understand that I must stay on the premise/on-site at the hypnotherapist’s office during all sessions for my child. I understand I can “listen in” on sessions from the waiting area and am free to consult the practitioner regarding any tools utilized during the sessions. I understand I will be given time prior to each session to discuss any areas of concern regarding my child’s circumstances/conditions. If additional time is needed to discuss issues concerning my child (but not in the presence of my child), I will need to schedule independent hypnosis sessions for myself. I understand sessions for multiple family members may be advisable if a crisis/transition has affected more than one person in your family unit.