Client Consent Form for Holistic Counselling at Signs of Abundance Hypnosis and Healing

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By continuing with one or more holistic counselling sessions with Signs of Abundance Hypnosis and Healing, I, the undersigned, hereby give my consent and agree to the following terms:

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1. Purpose of Consultation: I understand that the consultation is designed to gather information for clinical purposes to formulate customized treatment plans aimed at achieving my desired therapeutic outcomes.

2. Confidentiality of Health Information: I acknowledge that my health information will be recorded in a secure medical file. This information will not be released to any third parties unless I provide explicit consent or as required by law.

3. Inter-Provider Communication: I consent to the sharing and discussion of my health information amongst other healthcare providers involved in my treatment, as necessary for my medical support.

4. Accuracy of Information: I affirm that I have completed the intake form prior to consultation and that all information provided is honest, accurate, current, and true.

5. Disclosure of Medical Conditions: I agree to fully disclose any and all medical conditions and medical history, including any changes to my personal or health details, to my therapist.

6. No Guarantees of Results: I understand that results from the counselling sessions may vary and are not guaranteed.

7. Access to Information: I confirm that I have read or will read the information regarding consultation, assessment, and treatment available under the "Consultation" menu on EHA's website, ensuring I am informed of my consultation, treatment, therapeutic objectives, and outcome goals.

8. Emergency Contact Consent: In the event of an emergency or other significant situations, I consent to the release of my medical information to my designated contact support person as listed in my intake form.

9. Consent to Treatment: By signing this form, I provide my consent to participate in Holistic Mental Health Counselling Consultation and Customised Treatment Plan. I understand that this may include additional services offered by Signs of Abundance Hypnosis and Healing, such as meditation, hypnosis, or holistic therapies including Past Life Therapy and Inner Child Therapy.

10. Right to Withdraw: I understand that I have the right to terminate any session or treatment plan at my own discretion if I feel uncomfortable at any point.

11. Mandatory Reporting: I acknowledge that if I ever express thoughts of self-harm or harm to others, Tara J Clarke of Signs of Abundance has a legal obligation to report this to the appropriate authorities.

12. Mental Competence: I affirm that I am of sound mind and capable of understanding the contents of this consent form.

13. By continuing with the Health Declaration Online Form below, I am agreeing to all of these mentioned terms and conditions.

14. If you have a medical condition such as epilepsy or a heart problem that could lead to an emergency during an online session, you must arrange for a support person to be nearby—either in the same room or in an adjacent room—so Tara can reach them quickly if needed. This support person should be attentive and available on their phone during your session in case of disconnection. You acknowledge that a support person is only necessary if you have a medical issue that requires urgent assistance. If you do not have such a medical condition, having a support person present is not required.

15.  We kindly ask that you provide 48 hours' notice if you need to cancel or reschedule your session. This notice period allows us to offer your time slot to other clients. Unfortunately, if less than 48 hours' notice is given, we won’t be able to issue a refund, as we may have turned away others who needed that time. However, if you do provide 48 hours' notice, we will happily reschedule your session to a new date within the next two months. Thank you for your understanding!