INFORMED CONSENT FOR HYPNOSIS
Michelle A Leonard C.H. has informed me that hypnosis is a helpful technique and life tool for a variety of conditions. I understand that hypnosis is a way of inducing a pleasant, voluntary state of relaxed attentive concentration, an altered state of consciousness, during which the conscious critical mind is relaxed and relatively inactive, and the doorway to the subconscious, inner mind is opened with a person’s permission. In this comfortable state, suggestibility is heightened mental absorption is increased, the senses are heightened, and the imagination is activated in a controlled manner. The inner mind, subconscious, is more receptive to acceptable, beneficial suggestions. I understand that no one can be hypnotized against their will. You must be a willing subject. Your hypnotist must have your full cooperation. I understand that hypnosis is a collaborative and cooperative teacher-student type relationship. A hypnotized subject cannot be made to do anything he is not willing to do. A person must be a willing and cooperative subject for hypnosis to work. The hypnotized subject or client is not asleep. When a person is in hypnosis, he or she is relaxed and aware of his or her surroundings. He or she hears the sound of the hypnotist’s voice and will remember more or less of what the hypnotist says. The hypnotized subject or client is relaxed, comfortable, focused, and in a state of daydream type thinking. His or her analyzing, thinking mind, the Conscious mind, is turned off and his or her feeling and intuitive, creative mind, the Subconscious mind, is aware of everything that is going on. I understand that the requirements for being a good hypnotic subject are mainly the desire to be hypnotized and to experience hypnosis, the ability to concentrate, the willingness to cooperate and follow instructions, and the relative absence of mistrust and fear. I understand, Hypnotism is a self-regulating profession and its practitioners are not licensed by state governments. Michelle A Leonard C.H. is not a physician or 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 services are terminated by a client, the client has a right to coordinated transfer of services to another 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 a right to know the expected duration of sessions, and may assert any right without retaliation. Michelle Leonard C.H. does not treat, prescribe for, or diagnose any condition and is 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 New Jersey. Hypnosis is not considered nor is it a Psychological treatment. Hypnosis for subclinical purposes requires no referral. Michelle Leonard C.H. practices therapeutic hypnosis within the guidelines of the law set by the state of New Jersey. I understand, agree, and consent to treatment. I understand that hypnosis as practiced by Michelle A Leonard C.H. is not a medical treatment, but a process whereby an individual is taught to use his or her own abilities for his or her own benefit. With this understanding, I hereby grant consent and permission to Michelle A Leonard to hypnotize me. I understand, agree, and consent to treatment. This is my electronic signature
I understand, agree, and consent to treatment. This is my electronic signature.
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