Client Agreement - Code of Care
This document will be given to you at our Initial Consultation and we will both sign it.
The client will be treated with respect and care at all times.
Disclosure of all information during therapy and consultations remains confidential.
The hypnotherapist has a professional obligation to report to relevant authorities any concerns if they believe the client may be
intending to cause harm to themselves, the therapist or others.
A query on suitability or conflict of therapy with other treatment practitioners may have to be sought occasionally, with client
If receiving medical treatment of any kind, it is recommended that proper diagnosis is sought where relevant, to assist the therapist
and also to inform those professionals of your enquiries toward Hypnotherapy.
A full copy of The Association for Solution Focused Hypnotherapy’s Code of Practice is readily available.
This generally complies with that of the CNHC, a Department of Health supported Register on which I am a registered member.
The therapist has fully explained the procedures and treatment.
I understand that I will need to listen to the relaxation CD and to consider the content of the sessions in order to enhance the success of the treatment.
Although my ‘belief’ in my ability to change is not so important, I do understand the treatment’s success is linked to my ‘wanting’ to
change and therefore my commitment to the sessions.
I accept the fee payable and note the 24 hours notice of cancellation of appointment that is required, otherwise the fee will be
Respect for the client and therapist will be constantly maintained.
I have read the agreement above and accept the treatment on those terms.
Therapist’s Signature ____________________________
The General Data Protection Regulation (GDPR) is concerned with the personal information about you that I collect, store, and share.
This page details my GDPR policy.
PERSONAL INFORMATION I WILL COLLECT.
Gender (or preferred identity).
Date of Birth.
Telephone/SMS number (plus permission to send SMS & leave voice message).
Medical conditions relevant to Hypnotherapy.
HOW I WILL STORE YOUR PERSONAL INFORMATION.
Paper: written notes (described below).
Smartphone: I will store your contact information in a plain-text note app that backs up to my private Google Drive. This allows me to contact you in case of emergencies, but keeps from revealing this information to other applications (i.e. not using a Contacts app).
Email/SMS/WhatsApp: your email address and correspondence will be stored in my email account (currently Windows Live Mail) by nature of you contacting me. Your telephone number may be stored in my SMS or WhatsApp app should we exchange messages this way. Electronic correspondence will also be held by the corresponding app (Windows Live Mail) Phone's SMS, WhatsApp).
Website: none of your personal information is stored on my website, other than to momentarily collect & send it to my Gmail account for the purposes of our initial contact.
Client Care – Code of Care
Brief Session Notes
Contact name & telephone
Your email address will be used to send you my electronic newsletter only if you give consent for this.
HOW I MAY PROCESS/SHARE YOUR PERSONAL INFORMATION. CONSULTATION.
I seek a bi - monthly consultation with another therapist qualified in this process. The consultation process is for my practice (rather than seeking instruction on working with you). In order to protect your privacy, my consultant will not know you personally nor professionally and I will not refer to you by your name. This process does not affect the confidentiality of the work we do together.
If your health is in jeopardy (provided I have your consent) I may share your contact information with an emergency healthcare service (e.g. Mental Health Crisis Team).
If I have become aware of your intent to cause harm to another person/organisation (e.g. terrorism), the law may require that I inform an authority without seeking your permission. In such a situation, the law may require that I share your personal information without your knowledge (known as: whistle-blowing).
ERASING YOUR INFORMATION.
When we have finished working together, I will erase electronic copies of your information & correspondence within one month.
I will hold onto your written information for up to seven years past the end of our working together. This is so that I have a reference of our work in situations such as you returning to counselling in the future. After this time has passed, I will shred the written information.
You have the following rights...
To be informed what information I hold (i.e. this document).
To see the information I hold about you (free of charge for the initial request).
To rectify any inaccurate or incomplete personal information.
To withdraw consent to me using your personal information.
To request your personal information be erased (though I can decline whilst the information is needed for me to practice lawfully & competently).
NB: A printed copy of this statement will be given to you when we first meet for Hypnotherapy.. If we agree to continue working together, we will both sign the printed copy of this statement to indicate our agreement.