PLEASE FILL IN ALL QUESTIONS ON THIS QUESTIONAIRE AND CONSENT FORM IF YOU ARE HAVING QUIT DRINKING HYPNOTHERAPY PROGRAM WITH TARA J CLARKE AT SIGNS OF ABUNDANCE HYPNOSIS AND HEALING IN PERSON AT PALM COVE OR ONLINE VIA ZOOM CHAT.
This consent form is for those clients of Tara J Clarke that choose to have a STOP DRINKING program with Tara J Clarke that is in person, face to face in Palm Cove or online via Zoom chat. Please answer all questions below, for a smooth transition in your first session. We do this step so that we can keep the price down. Otherwise you are missing out on valuable time in the session, filling out this quite detailed form. Completion of this form, confirms that you have read this form and agree to engage in the process of Holistic Counselling and Hypnotherapy with Tara J Clarke at Signs of Abundance Hypnosis and Healing. By pressing the SUBMIT button once filled in all of the questions, you are agreeing to the terms and conditions on this form.
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Once you are paid in full, you will be directed to this part of the site to complete the consent form. This consent form is to be completed in full by yourself and assists in saving time in the questioning process, in your session. This in turn, saves you money as Tara then does not have to take you through these questions herself, in the therapy process. The questions asked on the form are an important part of the hypnotherapy and counselling process. Please complete this form only once you have paid in full for your session or program.
PLEASE READ ALL OF THE FOLLOWING
I agree to engage in the process of the following, with Tara J Clarke of Signs of Abundance Hypnosis and Healing: holistic counselling, psychotherapy, past life regression, Clinical or Regression hypnotherapy including shadow healing, ancestral or inner child hypnotherapy, meridian style tapping. I understand that I will have all choices at all times and can start and end the process at any time, even during my session. I am over age 18, and consent to these services offered by Tara J Clarke. I understand that after I leave this session I may receive a recording, depending on the circumstance. I acknowledge that listening to a recording is a crucial step in this process. Listening to the recording won’t bother me because I understand the importance of living in the present. If I partake in hypnosis as part of this healing process for a Holistic Counselling session, these services I am agreeing to, are held out to the public as non-therapeutic hypnotism, defined as the learning of self-hypnosis to induce positive thinking, create commitment to change and to learn the techniques of self-hypnosis and meditation to produce self-control over physical experiences and emotional awareness. I have been informed as to the limits of hypnosis effectiveness and offered referral to other providers of alternative approaches to problem solving. I agree to continue medication as prescribed by my attending Medical General Practitioner or Physicians, and understand that hypnotherapy, holistic counselling and all those already mentioned is not a substitute for medical care. I understand a hypnotist neither diagnoses nor treat any medical or mental health condition, instead offering tools of self-discovery and awareness to compliment any medical treatment prescribed by a physician. I understand that the methods of hypnosis include relaxation, breath work, creative visualization, positive affirmation, self awareness development and other techniques and may produce physical and emotional responses. I also understand that Tara J Clarke is not a doctor or nutritionist. If I need the advice of a doctor, psychologist, psychiatrist, personal trainer or a nutritionist, I will seek this out separately if needed. I also understand that if I choose to have a past life regression hypnosis with Tara J Clarke, I may go into a past life with my mind, enduring past life memories, and contact my higher self or subconscious for information and I understand that I am completely in control. As a result, I understand that I may remember parts of this session and I may retain memories of those past lives or past experiences. I also agree that if I choose to do any Akashic Records Readings, Soul Clearing or Past Life Regression Hypnosis that the idea is to let go of old blocks and in effect this lifts my vibration. I may also receive information on past lives and I am accepting of this information, negative or positive. I agree that after the session, in lifting the vibration, this may cause a shift in heightened emotions for a period of the first 21 days or so. I am aware of this and understand it is important to move through it naturally. Its part of the process. I agree to inform Tara J Clarke of any adverse feelings or experiences related to this process, at the time of my awareness of them. If any medical symptoms progress or become acute I agree to seek medical attention from a licensed healthcare provider. In the event of a medical emergency or if I feel suicidal, I will call 000 or other emergency help and I give permission for Tara J Clarke to call 000 in case of emergency. If seeking a session with Tara J Clarke in conjunction with my relationship with my spouse/partner I acknowledge that aspects of what may be discussed with Tara J. Clarke in my session may also be discussed and/or disclosed by Tara J. Clarke with my spouse/partner in their session, as I understand that transparency is important in this process, unless I give specific instruction otherwise in writing to Tara J. Clarke. I am of sound mind and completely understand what I have read.
ONCE YOU HAVE READ THIS STATEMENT AND AGREE WITH EVERYTHING ON THE STATEMENT, MOVE ON TO THE QUESTIONS BELOW, ANSWERING ALL QUESTIONS HONESTLY. WHEN YOU HAVE ANSWERED ALL QUESTIONS HONESTLY, PRESS THE SUBMIT BUTTON. BY TYPING YOUR NAME AT THE BOTTOM AND PRESSING THE SUBMIT BUTTON, YOU ARE AGREEING THAT YOU HAVE READ AND UNDERSTAND ALL OF THE QUESTIONS ON THIS FORM.
PLEASE COMPLETE THIS ONLINE CONSENT FORM PRIOR TO YOUR HOLISTIC COUNSELLING SESSION OR PROGRAM. IF YOU HAVE ORDERED A PROGRAM OF MORE THAN ONE SESSION, YOU ONLY NEED TO COMPLETE THIS FORM ONCE AND ALL QUESTIONS AND SUBMISSIONS APPLY TO ALL SESSIONS WITH TARA J CLARKE.
Failure to complete the online consent form before your session means you’ll have to do it at the beginning of your scheduled session, wasting session time. As a result, please complete the questions and submit this Holistic Counselling Consent Form as soon as possible. This process of filling in this form prior to your session, saves a lot of time in your session. On arrival you will require to sign your actual signature, in person. On arrival, you may be greeted by Tara's small dog, Benji. If you are allergic to dogs, please advise by return email to signsofabundance@gmail.com or phone: 0481336666 to inform Tara that you are allergic to animals and Tara will place Benji away earlier. Benji will be placed away from you, during the therapy or hypnosis part of your session. I am also aware and agree with the cancellation policy below.
REFUND AND CANCELLATION:
Once your session begins or is paid for, refunds are not available. As long as Tara J Clarke is notified beforehand, session times can be adjusted. If I change my mind about having a stop smoking program, a credit can be given to me for a session in another service on this site and is valid for 6 months from date of purchase.
IF ANY OF THESE QUESTIONS DO NOT APPLY TO YOU, WRITE N/A. I HAVE HELPED PEOPLE FROM ALL DIFFERENT BACKGROUNDS SO NOTHING SURPRISES ME AT ALL, I HAVE SEEN AND HEARD IT ALL. THE INFORMATION YOU PROVIDE IS PRIVATE AND CONFIDENTIAL. SO PLEASE BE HONEST WHEN ANSWERING THESE QUESTIONS AND DONT HOLD BACK. HONESTY WILL GET YOU THE BEST PROGRAM TO STOP DRINKING ALCOHOL !