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Home
About
About
Calendar
Directions
Staff
Testimonials
Trainings
Hypnotherapy Training
Shamanic Practices
Reiki/Energy Therapy
About Energy Therapy
Reiki I
Reiki II
Reiki Master Teacher
Energy Therapy Practitioner
Energy Boundaries
EFT
EFT II
Dowsing, Muscle Testing, Divination
Additional Classes
Munay Ki Rites
Clearing the Way
Meet-Ups
Monthly Hypnotherapist Meet-Up
Crystal Bowl Meditation
Modern Shamanism
Past Life Therapy & Integration
Advanced
About Advanced Classes
Quantum Consciousness Practitioner Training
Past-Life Therapy
Spirit Releasement Training
Sandplay Training
Internship
Resources
Free Reiki Clinic
Low Fee Clinic
IBRT Sponsored Membership
CE's
Holly's Page
Holly's Books
Blog Posts
CD Downloads
How Was Your Experience
Clinic Intakes
Client Intake Ilona
Client Intake Johnna
Client Intake Khrey
Client Intake Kristin
Client Intake Sarah
Client Intake Tyrone
Client Intake Annie
Client Intake Holly
Clinic Additional Forms Ilona
Clinic Additional Forms Johnna
Clinic Additional Forms Khrey
Clinic Additional Forms Kristin
Clinic Additional Forms Sarah
Clinic Additional Forms Tyrone
Clinic Additional Forms Annie
Clinic Additional Forms Holly
Records Release
I (Client)
*
First Name
Last Name
Give (HCH hypnotherapist)
*
Permission to release my hypnotherapy records to
*
For the purpose of:
*
This release is active until:
MM
DD
YYYY
Thank you!
Informed Consent Form
Regarding Recovered Memories and Legal Rights:
*
Research has found that memories uncovered during hypnosis, or other forms of induced altered state, may not be accurate or even factual. Memory is a constructive and reconstructive process. What is remembered about an event is shaped by what was observed, by conditions prevailing during attempts to remember, and by events occurring between observation and the attempted remembering. Memories can be altered, deleted, and created by events that occur during and after the time of encoding, during the period of memory storage, and during attempts at retrieval. Memories that occur either spontaneously or following the use of special procedures in therapy may be accurate, inaccurate, fabricated, or a fixture of these. This suggests that any memory uncovered during a hypnosis session be considered as a possible construct of mental process, and not necessarily an actual event. Therefore, in the event that during the course of hypnotherapy, memories should surface that may be considered grounds for future litigation, you may lose your legal right to use this information in a court of law, as it would not be admissible. If it should occur that certain types of memories begin to surface during the session with an HCH Hypnotherapy Intern under Holly Holmes-Meredith’s supervision, the session will be discussed so that you may decide whether or not to proceed further with the hypnosis, based on your understanding and careful consideration of the above information.
I have read the above and agree to participate in hypnotherapy.
Name
*
First Name
Last Name
Thank you!
Parent Permission To Work With A Minor
My Son/Daughter
*
First Name
Last Name
Has my permission to work with an HCH intern for the purposes of:
*
Parent/Legal Guardian
*
First Name
Last Name
Date
*
MM
DD
YYYY
Thank you!
Parent Permission For Release of Information of a Minor
I (Parent or Guardian)
*
First Name
Last Name
Request that:
*
Release written information or records on my daughter/son:
*
First Name
Last Name
To an HCH Institute intern for the purposes of:
In addition, I give permission for information to be exchanged verbally between the above mentioned parties. This release is active until :
MM
DD
YYYY
Please check:
*
Permission Granted
Thank you!