Fairfield County Hypnosis, LLC


CLIENT BILL OF RIGHTS/PROTECTION INFO


Contact Information:
My name is Karen B. Reiss. I can be contacted by telephone at (203) 502-2092.

Education and Training: I was trained in hypnosis at The National Guild of Hypnotists. I am a Certified Member of the National Guild of Hypnotists and I do annual continuing education to maintain my training at a high level.

My highest degree is a Master of Science in Education.

Notice: “THE STATE OF CONNECTICUT HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Under Connecticut law a hypnotist may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis or any other type of treatment from a different practitioner, the client may seek such services at any time. In the event my services are terminated by a client, the client has a right to coordinated transfer of services to another practitioner. A client has a right to refuse hypnosis services at any time. A client has a right to be free of physical, verbal or sexual abuse. A client has a right to know the expected duration of treatment, and may assert any right without retaliation.”

“The services I render are held out to the public as a form of motivational coaching combined with instruction in self-hypnosis. I do not represent my services as any form of health care or psychotherapy, and despite research to the contrary, by law I may make no health benefit claims for my services.”

Redress: I am a certified member of the National Guild of Hypnotists, and practice in accordance with its code of Ethics and Standards. If you ever have a complaint about my services or behavior that I cannot resolve for you personally, you may contact the National Guild of Hypnotists at P. O. Box, Merrimack, NH 03054-0308, (603) 429-9438, to seek redress. Other services than my own may be available to you in the community. You may locate such providers in the telephone book.

Fees: The charges for my services are $125 for the first session, and $100 for each additional session. My specialized services are as follows: Smoking Cessation Program (one session plus reinforcement tape) is $195; Weight Loss Program (three sessions plus reinforcement tape) is $395 Payment is expected as services are rendered. You will be given 30 days notice of any change in my fee schedule. If you are paying by check, please be certain that you have adequate funds in your account to cover the amount. There will be a $30 fee for all checks returned due to insufficient funds. If that occurs, you are responsible for making payment in full, by either a bank check, money order, or cash.

Confidentiality: I will not release any information to anyone without a written authorization from you, except as provided by law. You have a right to be allowed access to my written record about you.

Insurance: In general, insurance companies do not like to cover hypnotic services, and I caution you not to expect them to do so. Be aware that less than 10% of insurance companies cover hypnosis. I will file a standard one-page insurance form if you request without charge.

My Philosophy: I believe that hypnosis can be an amazingly effective tool to achieve more of the potential which we all possess. It can be used to improve a person’s general functioning, making a dramatic difference in lifestyle, success, and feeling of well being. It is a natural state of mind, and a wonderful way to take control of your life.

Client Signature: I have received and read this Client Bill of Rights and understand what I have read.


Client Name(print):_____________________________________

Client Signature:________________________________________