Client Agreement and Disclosure Statement
SPRYHYPNOTHERAPY, LLC – LAVINA SPRY, CTHt
Disclosure
Education and Training: Formally trained at the Florida Institute of Hypnotherapy, Tampa, FL; a Florida Department of Education state licensed school. I am certified and a member of the International Association of Interpersonal Hypnotherapists (IAIH), and I complete annual continuing education credits to maintain my training at a high level. I offer services as a certified clinical and transpersonal hypnotherapist.
Notice: AS THE STATE OF FLORIDA HAS NOT ADOPTED EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM, THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Hypnotism is a self-regulating profession, and its practitioners are not licensed by state governments. I am neither a physician nor a licensed health care provider and may not provide a medical diagnosis nor 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 a coordinated transfer to another practitioner. A client has the right to refuse services at any time and a client has the right to be free of physical, verbal, or sexual abuse. A client has the right to know the expected duration of sessions and may assert any right without retaliation.
Redress: As a certified member of the IAIH I practice in accordance with its Code of Ethics. As my client you have the right to refuse any aspect of your services, to completely terminate services at any time, or to choose another practitioner.
Rescheduling policy: Depending on the issue, please consider your commitment level. Clients are encouraged not to reschedule but if certain circumstances prevail and rescheduling becomes necessary then rescheduling can occur. However, it is suggested to discuss the commitment level. Block packages never expire. Individual and Package sessions are non-refundable. See Cancellation policy.
Confidentiality: I will not release any information to anyone without a written authorization from you except as provided for by law. You have a right to be allowed access to my written record about you. As my client you have the right to all complete and current information concerning any aspect of the professional/client relationship.
Insurance: Consider my services as something that you will pay for personally. That will both protect your privacy and help you value the work you are doing more. In general, most insurance companies do not cover hypnotic services, and I caution you not to expect them to do so.
Services available: Initial Assessment 30 mins – no charge. Single Hypnotherapy session $175.00. Block Hypnotherapy Session Packages are sold as a set of 3 $495.00 Breathwork $200.00 Past Life Regression/In Between Lives $200.00. Tuning Forks as an ADD ON $25.00 added to a service if requested, this option is not a standalone service.
Hypnotherapy Sessions may run from 50 mins to 2 hours, there are no additional charges if the session runs past 2 (two) hours. All services are prepaid and are due at the time of scheduling or booking by your app of choice; (Venmo:@Lavina-Spry, Cash App:$LavinaSpry or through PayPal:@Lavinaaspry). Sessions may be scheduled every two (2) weeks, this allows appropriate time for the body to adjust and process before the next session. Client Intake and Client Agreement with Disclosure must be on file before a session can occur.
My Approach: It is my goal to help you to achieve lasting results through the use of hypnosis, NLP, meditation, and other related self-help modalities. Through the power of your own mind, I will assist you in reaching your goals in a way that you and I both agree to be in your best interest, and in a way that is in compliance with state and federal laws, as well as with the standards of the organizations to which I belong.
SPRYHYPNOTHERAPY – LAVINA SPRY, CCHt
Agreement
Hypnotherapist agrees:
I agree to leverage my experience to facilitate the mutually agreed-upon changes that serve your best interests. Additionally, I commit to professionally assisting you in achieving your goals in a timely manner.
Client agrees:
I, the Client, am of legal age and acknowledge that I am willingly entering into a collaborative relationship. I understand that I will be an active participant in this partnership, which will utilize hypnotic techniques, regression, and other suitable methods.
Therefore, being of legal age or with a parental signature if under 18 years of age, my heirs, executors, administrators, and assignees, do hereby release and discharge Lavina Spry dba SpryHypnotherapy, LLC, and/or employees from all claims of damages, copyright, demands or actions whatsoever in any manner arising from or growing out of my cooperative participation.
I, the Client, understand that recordings may be made during my sessions for my personal ongoing use and with my preapproval and knowledge that Lavina Spry dba SpryHypnotherapy, LLC retains the copyright of these recordings. Any concerns or questions can be addressed with the International Association of Interpersonal Hypnotherapist as the governing and credentialing body.