Mind Medicine Hypnosis
Client Bill of Rights and Consent Form

Please READ AND SIGN this page, which includes the client’s bill or rights and consent form and my office policies.
NOTICE: Mind Medicine Hypnosis does not treat, prescribe for, or diagnose any condition. Mind Medicine Hypnosis has a properly trained facilitator of hypnosis and is not practicing any other profession that requires a license under the laws and regulations of the state of Pennsylvania. Hypnosis is not a substitute for medical or psychological treatment. Hypnosis for sub-clinical purposes requires no referral.
Fees:
Initial visit/ follow-up for General Hypnosis - $150
Group Sessions - As announced.
Payment is due in full at the time of service. Current payment methods include cash, MasterCard, Visa, and Discover card. Fees are subject to change however, current fees will be honored for six months (see also the cancellation and guarantee policy).
Cancellation Policy:
Mind Medicine Hypnosis values their time as it is their source of income and the schedule their hours by appointment. Your time is reserved exclusively for you. It is appreciated that you arrive promptly to obtain your full time slot. A 24-hour cancellation notice is required. Even with this notice, it is unlikely that your time slot will be able to be filled. Unless cancelled, you will be financially responsible for the time that you reserved. If you must cancel or reschedule an appointment due to an emergency, please notify Mind Medicine Hypnosis as soon as possible. Your efforts are appreciated in this matter.
Prepaid Visits:
The same policy applies to prepaid visits. A 24-hour cancellation notice is required, except in the case of an emergency. Failure to keep your appointment or short notice cancellations will result in the forfeiture of a prepaid visit. No refunds will be given for unused prepaid sessions. All prepaid visits will expire after twelve months.
Confidentiality:
Anything disclosed to Mind Medicine Hypnosis is held in strict confidence. Your information will not be released to anyone without written consent from you, except as provided for by law. You have a right to be allowed access to the written record held by Mind Medicine Hypnosis about you.
Minors:
Appointments or classes for children under the age of 18 require written permission from a parent or guardian who must accompany the client at the first appointment.
Insurance:
Mind Medicine Hypnosis does not file insurance or any other third party claims. Insurance companies usually consider hypnosis an alternative therapy and therefore do not cover it. Upon request, a statement for Flexible Spending Plans or Employer Programs will be provided.
Guarantees:
No guarantees as the effectiveness of hypnosis for your particular problems are made or implied, as it is impossible to guarantee human behavior or compliance. Hypnosis is a tool you use to help yourself; therefore no refund for services are given. Mind Medicine Hypnosis pledges its best efforts to help you to the best of their ability and wants nothing more than for you to succeed!
About Ron Dean, Certified Hypnotist (C.H.T):
I completed my training at Hypnodyne Foundation, I.C.B.C.H and the School of Professional Hypnotist to become a Certified Hypnotist. I have completed over 600 hundred hours of training and have become certified in clinical and medical hypnosis.
My Approach: I believe that individuals have the right to choose, or practice, alternative or complementary self-improvement service. Hypnosis is safe and non-invasive. It is a wonderful tool that you can use to help yourself. The services I render are held out to the public as a form of
motivational coaching and education, combined with instruction in self-hypnosis. I do not represent my services as any form of health care, psychotherapy or counseling and, despite research to the contrary, by law I may make no health benefit claims for my services. Hypnosis is not meant to be a substitute for psychological or professional counseling. If you have an ongoing mental health problem, please consult a professional licensed by the state of Pennsylvania. I use hypnosis to motivate clients to eliminate negative or unwanted habits, facilitate the learning process, improve memory and concentration, develop self-confidence, eliminate stage fright, improve athletic ability, reduce stress and for other social, educational, and cultural endeavors of a non-medical nature. In general, I help people cope with the normal problems of everyday living by utilizing various techniques of hypnosis. Hypnosis reduces stress, which is a beneficial adjunct for many medical or mental health disorders. Hypnosis can be used to reduce pain, discomfort, and improve certain health problems. For anything related to pain relief or other medical or mental health issues, I will need a written referral from your applicable licensed medical, dental, or mental health professional. All other issues are self-referrals.
Client Consent and Release:
I hereby agree, voluntarily and freely, to undergo hypnosis. I further release Ron Dean, Certified Hypnotist, and its employees and agents, from any and all claims of injuries, harmful effects, and all other consequences, whether or not presently known to me, which and release, and that I fully understand and agree to its terms. I acknowledge receipt of a copy of this statement.