Informed Consent

Informed Consent for Past Life Regression & Hypnotherapy

(Please read carefully. This is a legal and clinical record.)

1. Purpose & description of the procedure

I understand that Past Life Regression and hypnotherapy are therapeutic approaches that use guided relaxation and suggestion to facilitate emotional exploration and insight. The process includes an intake, a complimentary 90-minute interview to assess suitability, and the core sessions if both practitioner and client agree.

2. Structure & fees

The standard core program consists of three sessions; the bundle fee is $150 CAD, paid as one amount for the three core sessions. Each core session is typically 90 minutes.

3. Expected benefits

The intended benefit is emotional insight, symptom reduction, and increased self-understanding. Results are variable and not guaranteed.

4. Risks and limitations (important)

Hypnotherapy may produce vivid imagery, strong emotional responses, or recall-like experiences. These experiences can be symbolic and are not independently verifiable. There is a real risk of creating false memories. If you are concerned about memory accuracy or possible legal implications, please raise this during intake.

If you experience acute distress or safety concerns at any time, the session will be stopped and appropriate referral or emergency steps will be taken (see section on safety & escalation).

5. Contraindications

Regression/hypnosis is not recommended for individuals with active psychosis, uncontrolled suicidal ideation, or severe dissociative conditions. The intake screen will specifically check for these and may require referral.

6. Confidentiality and data handling

Your intake form and session notes are confidential clinical records stored securely. These records may be shared only with your explicit consent, except where disclosure is required by law (e.g., imminent risk of harm). The practice will maintain records in accordance with the privacy policy and applicable law.

Electronic records are stored securely, encrypted at rest, and accessible only to authorized staff. Cookie consent and data processing options are available on the website.

7. Voluntary participation & right to stop

Participation is voluntary. You may stop or withdraw consent at any time during a session. You remain in control of the process.

8. Emergency plan

If, during or after a session, you disclose suicidality or life-threatening risk, the practitioner will initiate escalation: immediate session termination, grounding exercises, contacting emergency services if indicated, and making referrals to psychiatric services.

9. Fees, cancellations and refunds

The three-session bundle is paid as described. Cancellation and refund policies are provided on the website. Please confirm you have read them before booking.

10. Consent to treatment

I have read and understand the above information. I have had the opportunity to ask questions and have received satisfactory answers. By signing below I consent to receive Past Life Regression / Hypnotherapy under the terms described.

Client Signature

Date

Practitioner Signature

Date