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Hypnotherapy Disclosure

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					                 Hypnotherapy Disclosure Form

Medical Disclosure
Valerie Odom Cobbin, is certified by the Sylvia Browne School of Hypnosis (SBSH).
Certification is required by the state of California. However, hypnosis is not a certified
practice in the state of California or Georgia. Valerie does not profess or imply that she
is a medical doctor or licensed mental health practitioner. Hypnosis is considered to be
an alternative to traditional medicine. Always follow the advice of your doctor.

Confidentiality
Your session is completely confidential. Any information discussed regarding your
session will be handled with the utmost discretion. You have the right to request, in
writing, the written information or notes from our session.

Warranty
No warranty is given, expressed or implied, for satisfactory results from the hypnosis
session. The hypnosis services provided are highly speculative in nature, and we cannot
guarantee the results will be satisfactory to the client.

Refund Policy
No refund is available to a client who does not show up or is late for their appointment.
A service is fully complete when a hypnosis session has gone for thirty minutes. Refunds
will not be given after the service is complete. Due to the preparation necessary for each
session, 48 hour cancellation is required, or there will be a $50.00 administrative fee
assessed.

 Recording
All sessions are recorded, at no charge to the client. Due to the nature of electronic
equipment, we cannot guarantee the tape will be fully audible, or usable.

Code of Ethics
Valerie Odom Cobbin has been certified by the Sylvia Browne School of Hypnosis.
However, she is not an employee of Sylvia Browne Corp., Society of Novus Spiritus or
Sylvia Browne Hypnosis Training Center. Valerie is committed to conducting her
practice and all professional interactions in strict accordance with the Code of Ethics of
the Sylvia Browne Hypnosis Training Center found at:
http://www.sylviabrownehypnosis.org/ethics.cfm.

My signature acknowledges that I have read and understand all of the above:

Date: _________

Printed Name:_____________________ Signature:_________________________

				
DOCUMENT INFO
Description: Clinical hypnosis is a procedure during which a qualified health professional or therapist (the “hypnotist”) gives a patient carefully worded instructions to follow with the goal of helping the patient enter a state of deep relaxation. In this hypnotic state, the “hypnotized” patient is aware of everything that is going on, but at the same time, becomes increasingly absorbed in using his or her imagination as directed by the hypnotist.