NLP and hypnosis disclosure form from EasyChangeWorks
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.
I, Jan Saeger, am a certified Practitioner, Master Practitioner, and Health Practitioner of NLP (Neuro-Linguistic Programming), and a certified hypnotist. I have hundreds of hours of NLP training and thousands of hours of experience.
No type of work I do is licensed by the state of California. My work is considered alternative or complementary to healing arts services licensed by the state. I am not a licensed physician.
The methods I use work with the way your mind and body naturally process information to help you get the results you want. I provide consulting, teaching, and coaching designed to help people achieve their goals and remove any barriers they have to success.
You may cancel or change your appointment free until 10 p.m. the night before your session. Email cancellations must be confirmed by 10 p.m. to count. If you cancel after 10 p.m., you will be charged your full session fee. As a courtesy, please give as much advance notice as possible.
Fees are due at the time the service is provided. Payment in advance may also be made for multiple sessions. Payment plans are available — please ask in advance.
I have read the above disclosure, cancellation policy, and payment policy. I understand that Jan Saeger's consultations are intended to be educational and performance-enhancing in nature, and are not intended as substitutes for medical services, psychotherapy, or counseling.
I agree to give sufficient notice of a cancellation, as specified above, or pay my full fee for that missed appointment. I agree to pay my fees on the day of each session or in advance.
My signature verifies that I have read and understand the above disclosure, and the above cancellation and payment policies, and I agree to their terms.
Signature _____________________________ Date _____________
Download this form in PDF format (20 K).
Disclaimer: I am not a lawyer and do not provide, or claim to provide, legal advice. Use of material on this site is purely at your own risk. I am not liable for any mistakes in the material presented here.
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