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Suitability Assessment
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Are you currently taking any medication?
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If Yes, what is it and why was it prescribed?
Are you currently under the care of another Therapist?
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Have you had Hypnotherapy before?
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Describe your alcohol consumption:
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I don't drink at all
Occasional binges
Every day
Occasionally
A glass or two at night
I use it to help me sleep
Describe your quality of sleep
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Variable
Have you ever suffered from any of the following?
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Depression
Chronic Insomnia
Addictions
Schizophrenia
Drug Abuse
Anxiety
Phobias
Compulsive Disorders
Eating disorders
Bipolar Disorders
Non of the above
Other
Do you suffer from any of the following?
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Respiratory Problems
Back or neck pain
Digestive Issues
Dizziness/Fainting
Psoriasis/Skin Complaints
High blood pressure
Non of the above
Other
What is it that you expect we can help you with?
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Performance Anxiety
Generalised Anxiety
Pain Relief
Social Anxiety
Weight Loss
Stop Drinking
Behavioural Modification
Study Skills
Work Stress
Depression
Trauma/PTSD
Addictions
Phobia
Confidence / Self Esteem
Stop Smoking
Other
How did you find out about the clinic?
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Doctor’s referral
Natural Therapy Pages
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Other
Would you like to be kept informed of workshops that would support and reinforce the work you have done here in the clinic
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Would you like to subscribe to free monthly hypnosis downloads?
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Would you be willing to answer a short questionnaire sometime in the future for research purposes?
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Cancellation Policy: I acknowledge that I, unless I give 24 hours notice of a session cancellation, I may be charged in full.
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I Agree
I Disagree
Disclosure: I understand that if I disclose that I have or intend to commit certain criminal offenses, the Therapist is obliged by law to report me to the authorities.
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I Agree
I Disagree
I also recognise that the therapist will use hypnosis as part of the treatment plan, and that I am seeking alternative/non medical treatment that may not be supported or endorsed by established medical
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I Agree
I Disagree
I understand that any audio provided contains powerful hypnotic suggestions. I therefore will not listen to any MP3 recordings whilst driving or operating machinery.
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I Agree
I Disagree
I have read the Terms and Conditions and agree
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I Agree
I Disagree
Missed appointments or appointments which are rescheduled with less than 48 hrs notice are chargeable at the full fee. This is further clarified at our initial meeting and is a minimum requirement to ensure fairness to other clients who may need that appointment. Exceptions can be made in the case of any emergencies of genuine sudden illness. Appointments need to be kept to make the necessary progress with your recovery. Most sessions are for one hour any lateness cannot be accommodated by adding additional time to the end of the sessions due to the impact on other clients. Think Hypnotic Solutions may also ask your permission to hold credit or debit card details on file in case of missed appointments. They are confidential and not shared with any third parties. We do not use the details, unless you don’t turn up or contact us. This is discussed at the initial consultation. For all appointments we take payment a week in advance each week. Initial Consultations Initial Consultations may take between 60 to 90 minutes in a professional and confidential environment to discuss your medical history and your expectoration with hypnotherapy. Depending on your requirement, your sessions may include up to 4 to 5 session. Subsequent sessions can be purchased with an added discount. Your initial consultation will also help determine whether hypnotherapy is the best course of action for you without any obligate or commitment to continue.
I have read the disclaimer
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I Agree
I Disagree
PLEASE READ CAREFULLY BEFORE USING THIS SITE. This site does not provide medical advice. The content is for informational purposes only. Consult with your Doctor (GP) on all medical issues regarding your condition and its treatment. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professional. Always seek the advice of your medical professional before making any changes to your treatment. Any medical questions should be directed to your personal doctor. Expectations of therapy: Each individual responds differently so we plan and tailor your therapy to best match your needs, individual requirements and personality type. We use a multi-modal approach to therapy based upon your individual needs. There are no guarantees that any of these courses of action will solve your issues. It is our intention to help you to help yourself, by facilitating a deep awareness of what is actually troubling you and helping you to empower yourself to make the appropriate changes. We can make no promises that we can help you, however, we can promise to do our best to help you. What you are paying for is our professional time and not necessarily a cure. We will ask you to do homework in between sessions and it is up to you to undertake these tasks in order to gain positive benefit and progression in your treatment and recovery. It is our experience that hypnotherapy and its approach can provide many beneficial effects; however, hypnosis does not substitute proper medical attention. Any material or information detailed on this site or on any merchandise is not intended to diagnose, treat, cure or protect against any disease or illness, always seek advice of a qualified doctor. Hypnotherapy downloads are not recommended for persons experiencing mental disorders or illness. Never listen to or play hypnosis tracks or audio whilst driving or operating equipment, always select an environment that is safe and secure. The audio products have been developed to assist you and give no guarantee; you yourself can be the only person that can provide a guarantee for your own success.
Are you a member of a health fund? N.B. Health fund rebates vary between funds and levels of cover. Additionally, changes in policy can occur at any time. We cannot tell you if your particular insurance policy will cover your hypnotherapy sessions, or what your rebate will be
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Do you consent to the use of hypnosis as a treatment tool during your clinical hypnosis
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