Terms & Conditions
Please understand that appointment times are limited. If you must cancel or reschedule your appointment, I respectfully request 24 hours notice. Missed appointments, or appointments cancelled without 24 hours notice, will incur a fee of $50.
Also, if you are more than 15 minutes late for your appointment, I may not be able to accommodate you. In this case, the same cancellation fee will apply.
I consent to participate in the process of hypnosis, with Kimberly Covert, CHt. of Next Level Hypnosis. I understand that hypnosis can involve the use of techniques such as progressive relaxation, meditation, guided imagery, as well as other helpful methods. As a part of hypnosis, clients are encouraged to recall events, circumstances, behaviors, thoughts, and feelings from prior situations in their life experience. I understand that clients vary greatly in their response to the relaxation and hypnotic process, with some clients having powerful experiences and others experiencing relatively little.
Additionally, I am aware that the experiences during hypnosis may be a combination of real and/or imagined. I also understand that certain memories/experiences may invoke emotional reactions. These emotionally charged experiences are oftentimes useful for facilitating insight and understanding; however, such powerful experiences can nonetheless be emotionally challenging for some clients.
My signature signifies that I have reviewed the above paragraphs, understand the principal characteristics of hypnosis, and agree to participate in this procedure. Furthermore, I understand that if at any time I become uncomfortable and/or unwilling to proceed with the hypnosis process, that I can request to stop the process and the hypnotic portion of the session will cease immediately
Release of Liability:
I understand that Kimberly Covert, CHt. of Next Level Hypnosis is not a medical doctor (physician, psychiatrist, psychologist, etc.) and makes no claim to diagnose or offer treatment of disease. I understand that hypnosis is not a replacement for medical treatment, psychological/psychiatric services, or counseling. I also understand that Kimberly does not treat or diagnose any condition and that she is a facilitator of hypnosis. I understand that, while Kimberly has my best interests in mind and will offer her guidance where asked, I am responsible for my own well-being and decision making. I also understand that I am responsible for my own interpretations of and reactions to the information presented to me. I understand that the experience of hypnosis is meant to present information that may contribute to mind, body, and spiritual balance and that Kimberly is not responsible or liable for the information I receive during the session. I also understand that Kimberly is not responsible my interpretations of the information or the decisions I make based on the information. I understand that I am responsible for my own judgment and that all participation, interpretations, and decisions are my own. I understand there are some conditions for which hypnosis may not be a good fit for the client. These conditions include (and are not limited to): Schizophrenia, pathological personalities, psychosis (including substance induced), senility, dementia, brain trauma, cognitive deficiencies, epilepsy, narcolepsy, bi-polar, clinical depression, suicidal tendencies, serious heart conditions, extremely high/low blood pressure, elderly/frail, substance abuse, and/or currently taking medications/substances that cause drowsiness. I understand that if I am, in any way, unsure if hypnosis would be a good fit for me, that it is best to consult my medical doctor prior to participating in hypnosis.
I understand that by e-signing this document, I am accepting full responsibility for monitoring my health for this and any future group and/or individual hypnosis sessions. Should the aforementioned conditions present themselves in the future, I understand and agree that I shall not participate in future sessions without first consulting with and receiving expressed consent from my health care provider. I have read and understand the above Release of Liability agreement. By my e-signature I consent to this agreement.
DISCLAIMER: By typing your name, you are signing this agreement electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.