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Policies, Procedures & Liability Release Form

As a client, you are responsible for adhering to all the following policies and procedures, please take a few minutes to review them.

Session Procedure: The client will call their hypnotherapist at the time of their session with the conference call number provided. The hypnotherapist does not call the client.

Session Length: All hypnotherapy sessions are 45 minutes in length.

Late Policy: If a client is more than 10 minutes late, the session is forfeited. This is because it becomes very difficult for the hypnotherapist to provide you with everything you need in a session that is shorter than 35 minutes in length. This typically results in the session running over, making the hypnotherapist late for her next client, which is unfair to both the hypnotherapist and the client. We have a strict adherence to this policy.

Cancellation / Rescheduling Policy:  All cancellations/rescheduling of a session must take place at least 24 hours before the session. Any cancellations/rescheduling taking place under 24 hours results in forfeiting the session.

No Show Policy:  All no show sessions are forfeited.

Sessions or Communication Outside of Grace Space Hypnosis:  All sessions and communication between client and hypnotherapist must always take place on a Grace Space Hypnosis conference call line, a Grace Space Hypnosis Skype account, or via a Grace Space Hypnosis email account. This is for quality assurance. If a hypnotherapist ever recommends moving your private sessions outside of Grace Space Hypnosis, please notify us immediately. Please do not jeopardize the position of your hypnotherapist with our company by suggesting that your sessions together take place outside of Grace Space.

Session Recordings: Recordings of the client's sessions are not included or provided, however, the client is welcome to record the session. It is not recommended that all sessions be listened to after the session is complete. Please be sure to check with your hypnotherapist as to whether a particular session would be beneficial to listen to again. If you would like a custom recording made by your hypnotherapist about a specific topic that will have studio sound quality, and will be custom just for you, you can order one. Prices range from $100-$500 depending on the hypnotherapist. You can also request that new topics be added to Grace Space if a recording you need is not already available in our database.

Recommended Length of Time Between Inner Circle Elite Sessions: Under Inner Circle Elite, you can schedule one monthly private session, which is highly recommended to maintain your progress towards the main areas you are working on.

Expiration Date for Inner Circle Elite Sessions: Each Inner Circle Elite session expires 30 days after joining or renewing your Elite subscription, therefore allowing you to schedule one private session per month.

Recommended Length of Time Between Regular Package Sessions (3, 6, or 12 session packages): We strongly recommend that clients schedule their sessions bought via a package no later than one week apart. This will allow for a compounding effect to take place within your subconscious mind.

Expiration Date for Private Session Packages: All packages expire 4 weeks beyond the length of the package, based on the date of purchase. This is to allow for illness, travel, availability of the hypnotherapist and anything else unexpected that could arise. This is also to ensure that the client will do their very best to schedule their sessions on a weekly basis to allow for the greatest amount of transformation to take place.

Package expiration timetable:

3 Sessions expire in 7 weeks from the purchase date.

6 Sessions expire in 10 weeks from the purchase date.

12 Sessions expire in 16 weeks from the purchase date.

By e-signing this document you confirm that you have read, understand, and agree to adhere to all Grace Space Hypnosis policies and procedures for private hypnotherapy sessions.


Date Signed: March 28, 2024

 

Grace Space LLC © 2018 Acknowledgement and Release of Liability Risks and Benefits of Hypnotherapy / Hypnosis / HypnoCoaching:

Hypnotherapy / Hypnosis / HypnoCoaching is a process in which we discuss a wide variety of issues, events, experiences, and memories for the purpose of creating positive change so you can experience life and relationships more fully. It provides you an opportunity to better, and more deeply, understand yourself, as well as any problems or difficulties you may be experiencing. Hypnotherapy / Hypnosis / HypnoCoaching is a joint effort between you and your hypnotherapist / hypnotist / hypnocoach . Progress and success may vary depending upon the particular problems or issues being addressed, as well as many other factors.

Participating in Hypnotherapy / Hypnosis / HypnoCoaching may result in a number of benefits, including, but not limited to, reduced stress and anxiety, a decrease in negative thoughts and self- sabotaging behaviors, improved interpersonal relationships, increased comfort in social, work, and family settings, increased capacity for intimacy with others, and increased self-confidence. Such benefits may also require substantial effort on your part, including an active participation in the therapeutic process, honesty, and a willingness to change feelings, thoughts, and behaviors. There is no guarantee that Hypnotherapy / Hypnosis / HypnoCoaching will yield any or all of the benefits listed above.

Participating in Hypnotherapy / Hypnosis / HypnoCoaching may also involve some discomfort, including remembering and discussing unpleasant events, feelings, and experiences. The process may evoke strong feelings of sadness, anger, fear, etc. There may be times in which your perceptions and assumptions are challenged, and different perspectives offered. The issues presented by you may result in unintended outcomes, including changes in your personal relationships. You should be aware that any decision on the status of a personal relationship is your responsibility.

During the therapeutic process, you may find that you feel worse before you feel better. For some, this is generally a normal course of events. Personal growth and change may be easy and swift at times, but may also be slow and frustrating. You should address any concerns you have

Grace Space LLC © 2018 Acknowledgement and Release of Liability regarding your progress in Hypnotherapy / Hypnosis / HypnoCoaching with your Hypnotherapist/ Hypnotist / HypnoCoach.

Acknowledgement and Release of Liability: By signing below, you acknowledge that you have reviewed and fully understand the terms and conditions of this Agreement. You have discussed such terms and conditions with your Hypnotherapist / Hypnotist / HypnoCoach, and have had any questions with regard to its terms and conditions answered to your satisfaction. You agree to abide by the terms and conditions of this Agreement and consent to participate in Hypnotherapy / Hypnosis / HypnoCoaching with your Hypnotherapist / Hypnotist / HypnoCoach.

Moreover, in consideration of the benefits to be derived from the counseling, the receipt whereof is hereby acknowledged, you hereby indemnify and hold harmless, release, remise and forever discharge and covenant not to sue or legally hold liable Grace Space Hypnotherapy,

Grace Space LLC, Katherine Grace Smith, Bernardo Haesbaert Feitosa, Kelly Kampf LCSW, Ginni Guiton, Jennifer Oliver, Kailah Cone, Sara Exley, the supervisors; or the staff from any and all claims, demands, damages, actions, or causes of action whatsoever related to the counseling process.

First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Signature*
Second Client's Name

First Name*

Middle Name

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Middle Name

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Middle Name

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Middle Name

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Middle Name

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

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Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

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Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

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Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Middle Name

Last Name*
Tenth Client's Date of Birth*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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