Therapy Consent formPlease complete the form below! Please provide your contact details below: * First Name Last Name Email * Phone (###) ### #### Do you agree for us to store and process your personal information? * Data Processing Consent In order to confirm your appointment, we need your permission to store and process your personal information. Your personal data and privacy is extremely important to us which is why we do not share this with any other parties. For more information please visit our Privacy Policy. You can always change your mind in the future. Simply email us! I agree I do not agree Do you agree to receive helpful articles, the latest research, therapeutic techniques, blog posts, recipes and menu plans from us? (Optional) Contact & Marketing Consent As part of providing our service to you, we will need to contact you. From time to time we share helpful articles, the latest research, therapeutic techniques, blog posts, recipes and menu plans. For more information please visit our Privacy Policy. I agree I do not agree I have read and agreed with the Therapy Agreement, Terms & Conditions and Privacy Policy * Your Therapy Agreement I understand that hypnosis is a natural induced state of relaxation, during which the Conscious and Subconscious mind are accessed more easily, so that it may focus my attention to be able to allow a modification or elimination of undesirable behaviours and influence change, only with my permission. I am a willing subject and understand that I cannot be made to do anything I do not want to do and there are no absolute guarantees as to the effectiveness of the treatment. I understand that all therapy is a collaboration between myself and the practitioner and as such I authorise the practitioner to use whatever therapeutic methods she deems appropriate, whilst remaining consistent with my good care. It is my decision to have therapy, including hypnotherapy, I take full responsibility for myself, and I relinquish the practitioner from any responsibility. Please read our Terms and Conditions here https://www.holisticallyherlife.com/terms-conditions and our Privacy Policy here https://www.holisticallyherlife.com/privacy-policy. Once you are satisfied, please click on the box below to accept. If the client is under 18 years of age, the Parent or Carer should check the box below on their behalf. I agree I do not agree Thank you for completing the form and confirming your agreement.Holistically Her Life