Client Agreement Form

In requesting professional consultation and assistance, I understand that to be successful I must be entirely willing to:

Recognise that my health and well-being depend directly on how well I care for myself, emotionally, physically, spiritually and intellectually.
Acknowledge that my feelings, thoughts, images and desires, conscious and subconscious, ultimately determine the course of every action and relationship in my life.
Realise that blaming anything or anyone, including myself, is totally useless and that the only person that can take charge of my life is me.
Accept responsibility for myself, my choices and actions, and that I, knowingly or unknowingly, create them.
Agree to be on time for my appointments, meet my financial obligations promptly (including any session missed without a 24 hour notice), and participate wholeheartedly in the work I am undertaking.
I know my heartfelt commitment is an important first step in my work here, and my signature below underscores that commitment. If, in all good conscience, however, I cannot align myself fully with each statement above, I agree to discuss in detail any reservations I may have.

First Name

Last Name

Date / Time

I have read and fully understand the above statements. All questions regarding the objectives pertaining to my care in this office have been answered to my complete satisfaction. I will not hold this clinic, Life in Sync, or any of the staff liable for any adverse effect on my health; nor will I hold this clinic, Life in Sync, or the staff liable if I choose to go against my doctor’s medical advice. I therefore accept counselling and hypnotherapy care on this basis.