CLIENT DISCLOSURE – ADVANCED HYPNOTHERAPY
Lynn Whitmire is a Hypnotherapist, certified Hypno-Anaesthesia therapist, certified Master Trainer, certified NLP Practitioner and approved EFT Practitioner. Client recognizes that the Hypnotherapist is not a licensed physician, psychiatrist or psychologist. The American Medical Association accepts hypnotherapy; however, it is not licensed by the State of California, nor are energy therapies.
Hypnosis is a natural, self-created state. The Hypnotherapist acts as a guide to help the client bypass the critical factor of the conscious mind, thereby, communicating directly with subconscious mind to make the changes he/she desires. Energy therapies work with the bodies “subtle energies” to release blockages along the energy meridians which are the cause of all negative emotions. Energy modalities may be used in conjunction with hypnotherapy.
Lynn Whitmire completed her internship, received her Mind-Body Hypnotherapist certification and Energy Modalities training at the School of Healing Arts. She received additional training in Pain Management, Anaesthesia, Hypnodontics and Childbirth to become recognized as a Hypno-Anaesthesia Therapist. She received her Master Trainer Certification through I.A.C.T. (the International Association of Counselors and Therapists) and teaches beginning and advanced hypnosis courses. Lynn studied with the founder of EFT, Gary Craig and also conducts basic and advanced EFT workshops. She has been certified as a life coach by the American Union of NLP and received her NLP certification through a Richard Bandler approved training. Lynn has worked with Shakti Rising - a program for young women with drug abuse and body image issues and at the Holistic Therapies Clinic in Pacific Beach. She has maintained a private practice in Pacific Beach for twenty years. She is a member of The International Medical and Dental Hypnotherapy Association, The Association for Comprehensive Energy Psychology, The American Board of Hypnotherapy, The International Hypnosis Federation and The National Guild of Hypnotists.
All services provided are done with the utmost concern for the client’s well being and in good faith. Results of the sessions are ultimately the client’s responsibility. This assumes all information provided by the client is true and complete. If you ever have any concerns about the nature of your treatment, please feel free to discuss it. In order to work with medical conditions, she must receive a release from your physician. It is recommended that you inform your medical doctor that you are receiving hypnotherapy treatment.
In order to use these services, California State law requires that you acknowledge receipt of the information provided in this form and that you sign it. You will receive a copy. Advanced Hypnotherapy will keep the original on file for at least three years. Hypnotherapy and energy therapies are alternative or complementary to healing arts that are licensed by the State of California. Under Sections 2053.5 and 2053.6 of California’s Business and Professions Code Lynn Whitmire can offer you these services subject to requirements and restrictions that are described fully on the attached information sheet.
Acknowledgement and consent to receive services
I have read and understand the above disclosure about the hypnotherapy and energy modalities offered by Lynn Whitmire her training and education. I have discussed with her the nature of the services to be provided. I understand that Lynn Whitmire is not a licensed physician and that hypnotherapy and energy therapies are not licensed by the state. I understand Lynn Whitmire does not diagnose, treat or cure. I understand it is my responsibility to maintain a relationship for myself/my child with a medical doctor. I have consented to use the services offered by Lynn Whitmire, and am personally responsible for the fees in connection with the services provided to me
Client Signature:_____________________________________________________________ Date:_______________________