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WEIGHT LOSS HYPNOTHERAPY ONLINE OR IN PERSON CONSENT FORM AND QUESTIONAIRE 

By completing this questionnaire yourself, you save money by requiring only a one-hour hypnotherapy session with Tara J Clarke, whether in person or online. If you prefer Tara J Clarke to conduct the questionnaire together during a sit-down meeting, please choose the two-hour session option, which does not require you to complete this questionaire. 

By proceeding with booking and participating in hypnotherapy, psychotherapy, regression hypnosis, holistic counselling, meridian tapping, and meditation services with Tara J Clarke—either online via video chat or in person at Palm Cove, Cairns—you acknowledge and agree to the following terms:

  1. Voluntary Participation and Autonomy
    You retain full control over your participation and may start, pause, or end the session at any time, including during the session.

  2. Age and Medical Disclosure
    You confirm that you are over 18 years of age and have never been diagnosed with psychosis or schizophrenia. You understand that hypnosis is contraindicated for individuals with these conditions.

  3. Session Safety and Disconnection Protocol
    In the event of a session disconnection, you agree to breathe calmly, focus inwardly, and safely bring yourself back to full awareness before opening your eyes. If you fall asleep, you may reconnect with Tara J Clarke to complete the session at a mutually convenient time. Should you feel uneasy after disconnection, you agree to contact Tara immediately via phone at 0481 336 666 (or +61 481 336 666 from overseas) or email for support.

  4. Health Conditions and Support Persons
    If you have a health condition such as epilepsy, you acknowledge the importance of having a support person present during the session to assist in case of adverse reactions. If you do not have such a condition, this precaution is not necessary.

  5. Recording and Post-Session Practice
    You will receive a recording of your session and understand that listening to this recording daily for at least one month, and up to several months, is an important part of reinforcing subconscious reprogramming.

  6. Nature and Scope of Services
    These services are provided as non-therapeutic hypnotism focused on teaching self-hypnosis techniques to promote positive thinking, commitment to change, and self-awareness. You acknowledge that hypnosis is not a medical treatment. You have been informed of its limitations and offered referrals to alternative providers as appropriate.

  7. Medical Care and Responsibility
    You agree to continue any prescribed medical treatments and understand that hypnotherapy and related services offered by Tara J Clarke are complementary tools and not substitutes for professional medical or mental health care. Tara J Clarke is not a medical doctor, nutritionist, or personal trainer and any such advice must be sought separately.

  8. Emotional and Physical Responses
    You acknowledge that hypnotherapy techniques—including relaxation, breath work, visualization, and affirmations—may elicit physical or emotional responses. You understand that emotional shifts or heightened feelings may occur for up to 21 days post-session and that this is a natural part of the process.

  9. Communication of Adverse Effects
    You agree to promptly inform Tara J Clarke of any adverse effects or concerns arising from the sessions. In case of any medical emergency or suicidal ideation, you will seek immediate professional help by calling emergency services (000) and authorize Tara J Clarke to do the same if required.

  10. Confidentiality and Shared Sessions
    If participating in sessions related to your relationship with a spouse or partner, you acknowledge that relevant information from your session may be shared by Tara J Clarke with your spouse or partner during their session, unless you explicitly instruct otherwise in writing.

By proceeding with your booking, you confirm that you have read, understood, and voluntarily agree to these terms and conditions. This consent serves as your formal agreement; no physical signature is required.


Once you have read this online consent form, please proceed with your booking to confirm that you have read and understand the terms and conditions. No signature is required, as your agreement is indicated by continuing with the booking.

ONLINE CONSENT FORM

Please fill out the following form
in order to participate in the session you have purchased.

Tick yes that you have read the above 'Online Consent Form' and that you agree to everything in the above mentioned.
What is your main motivation to drop the weight? What are you sick of? What are your goals? e.g. I am tired of being overweight and embarrassed when I have to sit on a bus. Please explain
What is your main motivation to drop the weight? What are you sick of? What are your goals? e.g. I am tired of being overweight and embarrassed when I have to sit on a bus. Please explain

Thanks for submitting!

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