SFH Online Agreement - Jayne Sarah Therapies

Name

First Last

Agreement for Solution Focused Hypnotherapy*

Please tick each box to show you accept and agree.

I understand the explanation of the hypnotherapy process and the treatment plan I have been given.
I understand that I will need to listen to the relaxation audio track every night to enhance the success of the treatment.
Although my 'belief' in my ability to change is not so important, I do understand the treatment success is linked to my 'wanting' to change and my commitment to the sessions.
I understand that I must commit to my sequential sessions as planned. Cancelling and rescheduling will not guarantee the best results for me.
I understand that I will need a quiet place to sit or lie down and a stable internet connection if I am having my sessions over Zoom or Skype.
I accept the fee payable (£55) and accept the full cancellation fee of £55 if I am unable to allow 24 hours notice of a cancellation or non-attendance.

Agreement for CORP (Clinical Outcomes and Research Programme)

Please tick each box to show you accept and agree. The more research we can gather to evidence that Solution Focused Therapy helps people, the sooner the NHS will be able to refer people to use our services. I will be grateful if you are willing to answer seven questions at the end of each session so that we can monitor your rate of improvement.

I understand that the information provided is confidential and will not be passed to a third party and will follow the rules laid down by GDPR.
I give informed consent and understand that the information provided will be part of a research programme.
I understand that the information provided will be completely anonymous

How did you hear about Jayne Sarah Therapies?

Word of Mouth
Google
Facebook
CNHC / Embody / NCH / AfSFH Website
Referral Voucher
Leaflet / Flyer
LinkedIn
Hypnotherapy Directory
Other

If a person told you about me, please name them:

GDPR*

I understand that any documentation stored about my therapy will be in accordance with GDPR as detailed in Jayne Sarah Therapies Privacy Policy

How may I respond to your enquiries?

Text
Email
Phone

How may I contact you with appointment reminders, rearrangements and cancellations?

Text
Email
Phone

Would you like me to email you with general information about Jayne Sarah Therapies, including special offers?

Yes

Would you like me to email you vouchers?

Yes

Vouchers include Gift vouchers, Birthday vouchers, Christmas vouchers, Thank you vouchers, Feedback vouchers and others.

Please can I email you a Feedback Form once you have completed your sessions?

Yes

How can I contact you with aftercare advice and relevant information?

Text
Email

Thanks for completing this form. Please press Submit.

Agreement for Online Solution Focused Hypnotherapy