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This is a legal listing of your rights and responsibilities.
Click here for a PDF downloadable of this form.

 

Nestles Hypnotherapy Empower Your Body, Emotions, Mind, and Spirit to Achieve …

Client Bill of Rights

Contact Information:

My name is Patricia / Robert Nestle. I can be contacted through my office via the following methods: by mail, Nestles Hypnotherapy PO Box 158 Morse Mill, MO 63066 (USA); or by telephone 314-541-0921 (USA); or by email pat at nestleshypnotherapy dot com or bob at nestleshypnotherapy dot com; or via the internet at http://www.nestleshypnotherapy.com.

 

Education and Training:

I was trained in hypnotherapy at Ferguson and Associates Hypnotherapy, an approved school through the National Guild of Hypnosis (http://www.ngh.net).  I am a certified member of the National Guild of Hypnotists and I do annual continuing education to maintain my training at a high level and my certification. The National Guild of Hypnotists is the oldest and largest hypnotism organization in the world and its certification is the most widely recognized credential for the professional practice of the hypnotic arts. I am also a certified Self Hypnosis Instructor through Ferguson and Associates.

 

Notice: AS THE STATE OF MISSOURI HAS NOT ADOPTED EDUCATION AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOSIS, THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Hypnotism is a self-regulating profession and its practitioners are not licensed by state government. I am neither a physician nor a licensed health care provider and may not provide a medical diagnosis nor recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis or any other type of treatment from a different practitioner, the client may seek such services at any time. In the event a client terminates my services, the client has a right to coordinated transfer of services to any practitioner. A client has the right to refuse hypnotism services at any time. A client has a right to be free of physical, verbal, or sexual abuse. A client has the right to know the expected duration of sessions, and may assert any right without retaliation.

 

Redress:

I am a certified member of the National Guild of Hypnotists, and practice in accordance with its Code of Ethics and Standards. If you have a complaint about my services or behavior that I cannot resolve for you personally, you may contact the National Guild of Hypnotists at PO Box 308, Merrimack, NH 03054-0308 (603) 429-9438 to seek redress. Services other than my own may be available to you in the community. You may locate such providers in the telephone book.

 

Fees:

The charge for my services is a $95.00 investment for your first private session. It is my pledge to keep your sessions to a minimum. If follow up sessions for the same challenge are desired, these are charged at a $75.00 investment each. These fees can be paid by credit/debit card, cash or checks. If your check is returned we reserve the right to pursue all legal avenues to collect including but not limited up to a $25.00 additional surcharge. Cancellation notice of 24 hours is suggested. If you cancel more than once without advance notice, we reserve the right to refuse services. Group Sessions, Discussion Groups, Educational Speaking Engagements, in-home and in-hospital sessions are on an as negotiated basis.

 

Confidentiality:

I will not release any information to anyone without a written authorization from you, except as provided by law. You have a right to be allowed access to my written record of your sessions.

 

Insurance:

I suggest you think of my services as something that you will pay for personally. That will both protect your privacy and help you value the work you are doing more. In general, insurance companies do not like to cover hypnotic services, and I caution you do not expect them to do so. If you wish to seek reimbursement from your insurance on your own, a receipt will be supplied on request.

 

My Approach:

It is our belief at Nestles Hypnotherapy that our minds are the greatest tool we possess. Our mission statement is to: “Empower your Body, Emotions, Mind, and Spirit to Achieve …” We at Nestles Hypnotherapy will do everything necessary to empower your subconscious mind to achieve your goals whether it is through private sessions, group sessions, or educational speaking engagements, we will help you to improve the quality of your life. All hypnosis is self-hypnosis; any results are YOUR results and not those of your hypnotist.

Pat and Bob Nestle, Certified Hypnotherapists' of Nestles Hypnotherapy.

Client Signature:

I have received and read this Client Bill of Rights and understand what I have read.

 

PRINT Client Name: __________________________________________________________________

 

Client Signature: __________________________________________________ Date: _____/____/____

 

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Disclaimer:
Hypnosis, Hypnotism, Hypnotherapy...

  • Cannot, and should not, stand alone as the sole medical or psychological intervention for any disorder.
    It is to be used in a complementary manner, not as an alternative.
  • Should not be used instead of appropriate medical, dental, or psychological treatment, and any individual with a medical or psychological problem should first consult a qualified health care provider for diagnosis and professional advice.
    It is to be used in a complementary manner, not as an alternative.
  • Is not intended to Diagnose, Treat, Cure, or Prevent any disease or illness.
  • Should only be practiced by those who have been appropriately trained, certified, who practice appropriately, and within the scope of their training and certification.

Contact Information
Telephone: 314-541-0921 (USA)
Postal address: Nestles Hypnotherapy PO Box 158 Morse Mill, MO 63066 (USA)
Email - info at nestleshypnotherapy dot com