1. I have been advised by Elaine Sparks the scope of the therapies she provides and give my full consent to receiving therapy sessions from her. I understand that results vary from person to person, and the agreement by Elaine Sparks to work on the issues or problems presented by me, using whatever model or models are appropriate to my situation, in no way implies or guarantees a ‘cure’ of the said issues or problems.
2. It has been explained to me by Elaine Sparks and I understand that hypnotherapy is a collaborative process, and the degree of progress is dependent on my active participation and engagement in the process. I understand that there are no guarantees offered and that success depends on my active participation and motivation. I understand that I am paying for Elaine Sparks' time and not for a guarantee of success.
3. I understand that Hypnotherapy, or any other therapy provided by Elaine Sparks is not a replacement for medical treatment, psychological or psychiatric services or the appropriate counselling. I also understand that Elaine Sparks does not treat, prescribe for, or diagnose any medical or mental health condition.
4. I declare that, if advised prior to any session with Elaine Sparks to seek medical approval, I have consulted with my General Practitioner and/or Hospital Consultant and gained the appropriate medical approval for working with Elaine Sparks
5. The number of sessions are discussed and agreed at the start and I agree to pay for any session prior to it taking place. Programmes expire if all sessions have not been completed within three months after the last session has been taken.
6. I understand and agree that my therapy sessions will take place in Elaine Sparks’ therapy room unless, by prior arrangement and in exceptional circumstances only.
7. I have been advised that I am free to terminate any or all sessions at any time. I have agreed to participate in each session to the best of my ability, and that contact between sessions will be strictly limited to telephone or e mail.
8. I have accurately and truthfully answered the questions on this form and provided background information as requested by Elaine Sparks
9. In the event of your withdrawal from a programme, for any reason whatsoever, you will remain responsible for the pro rata share of the package that has been delivered plus a cancellation fee of £30 for one session.
10. Confidentiality is paramount and will be maintained in all but the most exceptional
circumstances. I agree that these can include: legal action (criminal or civil court cases where
a court order is made demanding disclosure, including coroners’ courts); child abuse; if I am an
imminent danger to myself or others; and where there is good cause to believe that not to
disclose would cause danger of serious harm to others. Most standards of confidentiality applied
in professional contexts are based on the Common Law concept of confidentiality where the duty
to keep confidence is measured against the concept of ‘greater good’. The sharing of anonymous
case histories with supervisors and peer-support groups is not a breach of professional
confidentiality. The sharing of open case histories with supervisors and any referring NHS
medical practitioner is also not a breach.
PLEASE NOTE: Elaine Sparks reserves your sessions for you and it is her policy to charge the
full fee for cancellations received with less than 24 hours’ notice, or non-attendance.