Client Bill of Rights Education and Training: I was trained in Hypnotherapy at Leidecker Institute of hypnotherapy which is a state accredited program and school for hypnotherapy. I have over a hundred hours of course work and direction through the Leidecker Institute. I do participate in annual continuing education to maintain my current training at a high level. I have a Bachelors Degree in Physiology and minor in psychology from Southern Illinois University. Hypnotherapy is a self-regulating profession and its practitioners are not offered a license by state governments. I am not a physician nor a licensed health care provider and may not provide a medical diagnosis nor 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. Confidentiality: I will not release any information to anyone without a written authorization from you, except as provided for by law. My written record about you can be viewed by request as you choose. Insurance: In general, insurance companies do not like to cover hypnotherapy services. Fees: The charge for my services are $50.00 per session, payable upon each session in cash, or check. The fee includes an hour long session which is recorded for you to take home and use its benefits on a personal basis. My Approach: I personalize each session to meet the objectives of my clients chosen benefits for using hypnosis. I ask of each client to be open and honest so I may help them achieve their best possible outcome to their objective. My sole purpose is to be of assistance in helping you tap into the unlimited potential of the sub-conscious mind. If I have guided you in the direction of helping yourself by using hypnosis. I am grateful in the knowing that I have made a positive difference, in your experience of seeing the reflection of your success in your everyday rewards. I have received and read this Client Bill of Rights and understand what I have read. Client Name(please print):_______________________________________________________ Client Signature:________________________________________________________________ Date:________________________________________ Contact Info: Hypnotic Reflections Joe West Certified Hypnotherapist 930 Green Street Henry IL 61537 Phone: 309-356-5273 E-mail: josephwest@live.com