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NLP disclosure form from East Bay NLP Cafe

Summary: A disclosure form intended to comply with California's 2002 alternative health care law, which provides legal protection for practitioners of alternative health care.

At the January 2004 meeting, the group discussed and then drafted disclosure forms to meet the requirements of the new California alternative health care law, SB577. (Read the full text of the law.)

Note: SB577 applies to physical and mental health care. If you do business NLP in group settings, you are probably legal — but if you do a reimprinting on an individual there, you might be liable under the new law unless you have the client sign a disclosure. (We're not lawyers, and we don't know.)

Since a lot of people's eyes glaze over when presented with an intimidating legal form, the group decided to create the shortest, simplest version that would meet the legal requirements. Here it is:

I, [name], provide consulting, teaching, and coaching. I am a certified [Practitioner / Master Practitioner / Health Practitioner] of NLP (Neuro-Linguistic Programming) [, and a certified hypnotist / life coach / other qualifications].

NLP is not medically certified. It is considered a complementary or alternative healing arts service that is not licensed by the state. I am not a licensed physician.

Individual NLPers provide very different services, depending on their focus and training. Insert here a short, nominalized description of (a) the nature of the services you provide, and (b) the theory of treatment on which your services are based. The latter could be something as nominalized as "NLP uses the way the mind and body naturally work to help people get the changes they want." (We're not lawyers and this isn't legal advice. If you have any questions or concerns, check with a lawyer.)

Cancellation policy

[specify — here's my version and Pati McDermott's version]

Payment policy

Fees are due at the time the service is provided. Payment in advance may also be made for multiple sessions.

I understand that [name]'s consultations are intended to be educational and/or performance coaching in nature, and are not intended to be psychotherapy or any other type of licensed therapy services.

I have read the above cancellation policy, and agree to give sufficient notice of a cancellation, as specified above, or pay my full fee for that missed appointment.

I have read the above payment policy and I agree to pay my fees on the day of each session or in advance.

My signature verifies that I have read and understood the above disclaimer, and I agree to its terms.

Signature: ____________________________________________
Name (printed):________________________________________

Disclaimer: EasyChangeWorks staff and members of East Bay NLP Cafe are not lawyers and do not provide, or claim to provide, legal advice. Use of material on this website is purely at your own risk. We are not liable for any mistakes in the material presented here.


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