TERMS AND CONDITIONS
I am not responsible for any claims as each client differs in response and cooperation. Fees paid will not be refunded under any circumstances. TIME GIVEN IS MONEY. If you need to cancel or reschedule your appointment please give me a two-day (48 hour) notice.
Being Free will not release any information to anyone without a written authorization from the client, except as provided by law. The client has a right to access any records of sessions. All requests for release of any information to a client or other person must be supported by a clear Authorization to Release Direction signed by the client and a picture ID of that client (if not requested in person). Only Dr. Anupama Sharma has access to client information. We realize that there are subjects and incidents that are so sensitive that extra efforts must be made to make the healing process comfortable for and accessible to all.
I hereby authorize Dr. Anupama Sharma to hypnotize me for the purposes outlined in this intake form and for the future purposes that I may request. I understand that the success of my hypnosis therapy depends greatly on my own ability and desire to effect change in myself. I understand that the results of my sessions depend greatly on my own serious participation, and that Dr. Sharma cannot offer any guarantee of the success of my treatment. I am aware, however, that Dr. Sharma will do everything in her power to ensure my success. I also understand that I have other choices from which to seek assistance regarding my specific concerns, and I have chosen hypnotherapy at this time. I understand that during the hypnotherapy session, Dr. Sharma may touch me as an anchoring technique. I hereby give my permission for such touch to take place during my session.