• I have been advised by Priya Rohan on the scope of the therapies she provides and give my full consent to receiving therapy sessions from Priya Rohan. I understand that results vary from person to person, and the agreement by Priya Rohan to work on the issues or problems presented by me, using whatever therapy model or models are appropriate to my situation, in no way implies or guarantees a ‘cure’ of the said issues or problems.
• It has been explained to me by Priya Rohan and I understand that hypnotherapy is a collaborative process, and the degree of progress is dependent on my active participation and engagement in the process. I understand that there are no guarantees offered and that success depends on my active participation and motivation. I understand that I am paying for Priya Rohan’s time and not for a guarantee of success.
• I understand that Hypnotherapy or any other therapy provided by Priya Rohan is not a replacement for medical treatment, psychological or psychiatric services, or the appropriate counseling. I also understand that Priya Rohan does not treat, prescribe for, or diagnose any medical or mental health condition.
• I declare that, if advised prior to any session with Priya Rohan to seek medical approval, I have consulted with my General Practitioner and/or Hospital Consultant and gained the appropriate medical approval for working with Priya Rohan
• The number of sessions is discussed and agreed upon at the start and I agree to pay for any session prior to it taking place.
• I understand and agree that my therapy sessions will take place in Priya Rohan’s therapy room or online or in the client’s house in the presence of a female staff brought in by the therapist. unless by prior arrangement and in exceptional circumstances only.
• I have been advised that I am free to terminate any or all sessions at any time. I have agreed to participate in each session to the best of my ability, and that contact between sessions will be strictly limited to telephone or email.
• I have accurately and truthfully answered the questions on this form and provided background information as requested by Priya Rohan
• I understand that any mp3 download/CD/ any material that is provided for me is at Priya Rohan’s discretion. I agree that any such mp3 download or CD or material is for my personal use only and that it is not to be lent, copied, or sold under any circumstances.
• Confidentiality is paramount and will be maintained in all but the most exceptional circumstances. I agree that these can include: legal action (criminal or civil court cases where a court order is made demanding disclosure, including coroners’ courts); child abuse; if I am an imminent danger to myself or others; and where there is good cause to believe that not to disclose would cause danger of serious harm to others. Most standards of confidentiality applied in professional contexts are based on the Common Law concept of confidentiality where the duty to keep confidence is measured against the concept of ‘greater good’. The sharing of anonymous case histories with supervisors and peer-support groups is not a breach of professional confidentiality. The sharing of open case histories with supervisors and any referring personal medical practitioner is also not a breach.
• I hereby authorize the therapist named below to use various mental health techniques on me for the purposes outlined in this form, and for future purposes that I may request.
• I understand that hypnosis, regression therapy, and other therapies are not medical procedures and that no medical benefits are being offered to me.
• I understand that the success of therapy depends on my ability to relax, and my desire to create change in myself.
• I understand and I am willing to take the holistic healing through lifestyle coaching therapies provided by Priya Rohan.
• I understand that, because the results of the sessions depend on my own serious participation, the hypnotherapist cannot offer any guarantee of the success of my treatment. I am aware, however, that they will do everything reasonable in their ability to ensure my success.

PLEASE NOTE: Priya Rohan reserves your sessions for you and it is her policy to charge the full fee for cancellations received with less than 48 hours’ notice, or non-attendance. By signing below, you agree to this.

I agree to the terms stated above.