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CLIENT
BILL OF RIGHTS/PROTECTION
INFO
Contact Information: My name is Karen B. Reiss. I can
be contacted by telephone at (203) 502-2092.
Education and Training: I was trained in hypnosis
at The National Guild of Hypnotists. I am a Certified Member of
the National Guild of Hypnotists and I do annual continuing education
to maintain my training at a high level.
My
highest degree is a Master of Science in Education.
Notice:
“THE STATE OF CONNECTICUT HAS NOT ADOPTED ANY EDUCATIONAL
AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM. THIS STATEMENT
OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Under
Connecticut law a hypnotist may not provide a medical diagnosis
or recommend discontinuance of medically prescribed treatments.
If a client desires a diagnosis or any other type of treatment from
a different practitioner, the client may seek such services at any
time. In the event my services are terminated by a client, the client
has a right to coordinated transfer of services to another practitioner.
A client has a right to refuse hypnosis services at any time. A
client has a right to be free of physical, verbal or sexual abuse.
A client has a right to know the expected duration of treatment,
and may assert any right without retaliation.”
“The
services I render are held out to the public as a form of motivational
coaching combined with instruction in self-hypnosis. I do not represent
my services as any form of health care or psychotherapy, and despite
research to the contrary, by law I may make no health benefit claims
for my services.”
Redress: I am a certified member of the National
Guild of Hypnotists, and practice in accordance with its code of
Ethics and Standards. If you ever have a complaint about my services
or behavior that I cannot resolve for you personally, you may contact
the National Guild of Hypnotists at P. O. Box, Merrimack, NH 03054-0308,
(603) 429-9438, to seek redress. Other services than my own may
be available to you in the community. You may locate such providers
in the telephone book.
Fees: The charges for my services are $125
for the first session, and $100 for each additional session. My
specialized services are as follows: Smoking Cessation Program
(one session plus reinforcement tape) is $195; Weight Loss Program
(three sessions plus reinforcement tape) is $395 Payment is expected
as services are rendered. You will be given 30 days
notice of any change in my fee schedule. If you are paying by check,
please be certain that you have adequate funds in your account
to
cover the amount. There will be a $30 fee for all checks returned
due to insufficient funds. If that occurs, you are responsible
for
making payment in full, by either a bank check, money order, or
cash.
Confidentiality:
I will not release any information to anyone without a written
authorization from you, except as provided by law. You have a right
to be allowed access to my written record about you.
Insurance: In general, insurance companies
do not like to cover hypnotic services, and I caution you not to
expect them to do so. Be aware that less than 10% of insurance companies
cover hypnosis. I will file a standard one-page insurance form if
you request without charge.
My Philosophy: I believe that hypnosis can
be an amazingly effective tool to achieve more of the potential
which we all possess. It can be used to improve a person’s
general functioning, making a dramatic difference in lifestyle,
success, and feeling of well being. It is a natural state of mind,
and a wonderful way to take control of your life.
Client Signature: I have received and
read this Client Bill of Rights and understand what I have read.
Client Name(print):_____________________________________
Client
Signature:________________________________________
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