Loading...

Program Description:

Hypnotherapy Program

Program Structure: 

- Sessions are typically 45 minutes in length but if we need more time together I allow for that in my schedule.
- As your HypnoCoach I am available to you by text and email whenever you need. That does not mean I'll always be able to respond right away, but it does mean that you can reach out at anytime and you will hear back from me as soon as I am able. 

POLICIES AND PROCEDURES:

Welcome to Grace Space Hypnotherapy!

As a client, you are responsible for adhering to all of the following policies and procedures, so please do take a few minutes now to review them all.

Session Length:
All hypnotherapy sessions are 45 minutes in length.

Late Policy:
If a client is more than 10 minutes late, the session is forfeited. This is because it becomes very difficult for the hypnotherapist to provide you with everything you need in a session that is shorter than 35 minutes in length. This typically results in the session running over, making the hypnotherapist late for her next client, which is unfair to both the hypnotherapist and the client. We have a strict adherence to this policy.

Cancellation / Rescheduling Policy:
All cancellations/rescheduling of a session must take place at least 24 hours before the session. Any cancellations/rescheduling taking place under 24 hours results in forfeiting the session.

No Show Policy:
All no show sessions are forfeited. 

Session Recordings:
Recordings of the client's sessions are not included or provided, however, the client is welcome to record the session. It is not recommended that all sessions be listened to after the session is complete. Please be sure to check with your hypnotherapist as to whether a particular session would be beneficial to listen to again. 

Recommended Length of Time Between Sessions:
We strongly recommend that clients schedule their sessions no later than one week apart. This will allow for a compounding effect to take place within your subconscious mind. 

Payment/Refunds:
Payments referred to herein shall not be refundable under any circumstances, including but not limited to the extension or termination of this Agreement for whatever reason. 

By e-signing this document you confirm that you have read, understand, and agree to adhere to all Grace Space Hypnosis policies and procedures for private hypnotherapy sessions and the terms and conditions of this agreement.

 

 

Date Signed: April 25, 2024

 

Executive HypnoCoaching / GraceSmithTV LLC © 2020 Acknowledgement and Release of Liability Risks and Benefits of Hypnotherapy / Hypnosis / HypnoCoaching:

Hypnotherapy / Hypnosis / HypnoCoaching is a process in which we discuss a wide variety of issues, events, experiences, and memories for the purpose of creating positive change so you can experience life and relationships more fully. It provides you an opportunity to better, and more deeply, understand yourself, as well as any problems or difficulties you may be experiencing. Hypnotherapy / Hypnosis / HypnoCoaching is a joint effort between you and your hypnotherapist / hypnotist / hypnocoach . Progress and success may vary depending upon the particular problems or issues being addressed, as well as many other factors.

Participating in Hypnotherapy / Hypnosis / HypnoCoaching may result in a number of benefits, including, but not limited to, reduced stress and anxiety, a decrease in negative thoughts and self- sabotaging behaviors, improved interpersonal relationships, increased comfort in social, work, and family settings, increased capacity for intimacy with others, and increased self-confidence. Such benefits may also require substantial effort on your part, including an active participation in the therapeutic process, honesty, and a willingness to change feelings, thoughts, and behaviors. There is no guarantee that Hypnotherapy / Hypnosis / HypnoCoaching will yield any or all of the benefits listed above.

Participating in Hypnotherapy / Hypnosis / HypnoCoaching may also involve some discomfort, including remembering and discussing unpleasant events, feelings, and experiences. The process may evoke strong feelings of sadness, anger, fear, etc. There may be times in which your perceptions and assumptions are challenged, and different perspectives offered. The issues presented by you may result in unintended outcomes, including changes in your personal relationships. You should be aware that any decision on the status of a personal relationship is your responsibility.

During the therapeutic process, you may find that you feel worse before you feel better. For some, this is generally a normal course of events. Personal growth and change may be easy and swift at times, but may also be slow and frustrating. You should address any concerns you have

Executive HypnoCoaching / GraceSmithTV LLC © 2020 Acknowledgement and Release of Liability regarding your progress in Hypnotherapy / Hypnosis / HypnoCoaching with your Hypnotherapist/ Hypnotist / HypnoCoach.

Acknowledgement and Release of Liability: By signing below, you acknowledge that you have reviewed and fully understand the terms and conditions of this Agreement. You have discussed such terms and conditions with your Hypnotherapist / Hypnotist / HypnoCoach, and have had any questions with regard to its terms and conditions answered to your satisfaction. You agree to abide by the terms and conditions of this Agreement and consent to participate in Hypnotherapy / Hypnosis / HypnoCoaching with your Hypnotherapist / Hypnotist / HypnoCoach.

Moreover, in consideration of the benefits to be derived from the counseling, the receipt whereof is hereby acknowledged, you hereby indemnify and hold harmless, release, remise and forever discharge and covenant not to sue or legally hold liable Grace Space Hypnotherapy,

Executive HypnoCoaching / GraceSmithTV LLC, Katherine Grace Smith, Bernardo Haesbaert Feitosa, Ginni Guiton, Jennifer Oliver, Kailah Cone, Brooke Baraz, Shama Dhanani, Shonda Howard, Amy Hunt, Tiff Zapico, the supervisors; or the staff from any and all claims, demands, damages, actions, or causes of action whatsoever related to the counseling process.

First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Signature*
Second Client's Name

First Name*

Middle Name

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Middle Name

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Middle Name

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Middle Name

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Middle Name

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

Middle Name

Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

Middle Name

Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

Middle Name

Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Middle Name

Last Name*
Tenth Client's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!