Non-Medical Nature of Treatment:
I understand that neither Hypnosis, Life Coaching nor NLP are substitutes for medical attention.
Counseling is not a substitute for a physician's role in monitoring and treating my medical
I understand that no counseling methods, including Hypnosis, Life Coaching and NLP, can
guarantee effectiveness. Hypnotism and Hypnotherapy are self-regulated professions and its
practitioners are not licensed by state government.
No information will be released without written authorization from the client, except as provided
The client agrees to pay $135 for a 60-minute session (excluding regression and smoking
cessation sessions) until treatment is terminated either by client or the therapist. Session length
can be from 40 minutes to 1 1/2 hours at the discretion of the therapist.
It is recommended that the client thinks of these services as something that they will be paying
for personally. This protects the client’s privacy and often increases the personal value of the
work completed. In general, insurance companies do not cover hypnosis related therapy, NLP
or Life Coaching. Do not anticipate them to do so. A payment receipt for services is available
The client agrees to pay $135 for any missed appointments (48 hour notice required to avoid
this fee). Fees may billed to the credit card on file for cient’s account.
VOLUNTARY CONSENT FOR SERVICES
I have read and understand the General Acceptance Form. I hereby request and consent to
participate in services provided by Riverwalk Hypnosis and Wellness Center LLC, including
follow-up contact to evaluate the effectiveness of the services provided.