Child Client Agreement – Hypnotherapy Code of Care
Click here to download the PDF version.
The therapist has fully explained Hypnotherapy, together with any self-help on my part and/or my child’s part.
Hypnotherapy results vary from person to person.
I accept the fee payable and note the 24 hours’ notice of cancellation of appointment that is required; otherwise half the fee will be charged.
I understand that Hypnotherapy may involve light touch on occasion but full clothing is retained. Respect for the child, the client, and body privacy will be constantly maintained.
The therapist reserves the right to refuse or postpone treatment if they feel threatened or disrespected.
I explicitly consent to you creating and storing records concerning my child’s Hypnotherapy sessions, as per your Privacy Notice, a copy of which I have seen.
I have read and understand both pages of this agreement and give permission for Hypnotherapy to take place.
Parent/Guardian of: ________________________________
Signed: ______________________________________________
Print Name: ______________________________ Date: _____________________
Therapist: ________________________________ Date: _____________________
Print Name: Amy Armstrong MA (Oxon).DSFH.HPD.MNCH(Reg).CNHC(Reg)
Promotional information
For the purposes of promoting health and wellbeing, The Executive Alchemist would like to stay in touch with you with information that may be of interest to you. (For example, occasionally we send past and current clients links to free webinars, new relaxation tracks and resources to reduce stress). You can change your mind at any time by contacting Amy Armstrong as per our Privacy Policy or clicking the unsubscribe option included in our emails. We will treat your information with respect.
For providing promotional information you can stay in touch with me using the following methods.
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Signed: ________________________________ Date: _____________________
Parental/Guardian Consent
I understand that as parent/guardian of……………………………………………………………..(print name) I must give consent before a child under 16 years of age (or under 18, (Gillick competence)) can receive Hypnotherapy and that I or an agreed adult will also accompany the above person to their appointments and stay on the premises during the appointment.
I have been informed by Amy Armstrong (Hypnotherapist) that I must consult a doctor concerning the health and wellbeing of my charge, according to law.
I have asked about/seen the current DBS certificate of the Hypnotherapist. The client will be treated with respect and care at all times.
Disclosure of all information during therapy and consultations remains confidential, see below.
- The Hypnotherapist has a professional obligation to report to relevant authorities any suspicion of abuse or harm to a child.
- The Hypnotherapist has a professional obligation to report to relevant authorities any concerns if they believe the client, guardian or child may be intending to cause harm to themselves, the therapist or others.
- A query on suitability or conflict of therapy with other treatment practitioners may have to be sought occasionally, with client/guardian knowledge.
- I have regular supervision as part of my professional practice. I may discuss your child’s case with other qualified Hypnotherapists. I will not identify your child in these supervision sessions.
NB. If receiving medical treatment of any kind, it is recommended that you inform those professionals of your enquiries about Hypnotherapy.
It is recommended that you consult your child’s doctor before starting any complementary therapies, including Hypnotherapy. It’s important to note that results may vary from person to person.
Privacy Policy
Who are we? You know me as Amy Armstrong, and work with me via ‘The Executive Alchemist’, which is a trading name for my rather boringly titled company ‘QA Solutions (Associates) Limited.’ I am the data controller of QA Solutions (Associates) Limited and can be contacted via amy@amyarmstrongcoaching.com.
At The Executive Alchemist, we are committed to maintaining the trust and confidence of our clients. In particular, we want you to know that we are not in the business of selling, renting or trading email lists with other companies and businesses for marketing purposes. We just don’t do that sort of thing. This Privacy Policy provides lots of detailed information on when and why we collect your personal information, how we use it, the limited conditions under which we may disclose it to others, and how we keep it secure.
What types of data do we collect? As part of the registration process for working with
What do we use this information for? Primarily the information is used to provide the services specified under our contract with you i.e. to help us tailor your coaching to support you to meet your goals for working with us.
In addition, we use it to contact you to arrange sessions; to send you additional information to support your work with us; to send you the occasional email or newsletter about topics you’ve said you’re interested in; to contact you if we need to obtain or provide additional information; to check our records are right and to check every now and then that you’re happy and satisfied. We also use it as necessary to comply with any present or future law, rule, regulation, guidance or directive; to comply with industry or professional rules and regulations including voluntary codes, and discussions with our supervisors; to comply with demands or requests made by any relevant insurance process, or in connection with any litigation. We will hold your personal information for as long as it is necessary for the relevant service to be provided, and for eight years thereafter (or until you reach 25 in the case of someone 18 years old and below) as required by relevant professional codes of practice.
We use a third-party provider, Acuity Scheduling, to manage our online bookings. You are able to do this yourself and register for an account with them.
We use a different third-party provider, MailChimp, to deliver the occasional newsletter or group email to those of you who have opted in for these services. We gather statistics around email opening and clicks using
We use the technology platforms of Skype, Zoom and Cliniko to enable online sessions. We do not share your details with any of these providers. Please review the individual privacy policy of each of these providers for details of how they ensure the security of their service provision. Should we lose connectivity during our sessions together, I will try to reconnect with you immediately, and after a further minute. Should this fail, I will call you and we will agree whether to continue by phone, try to reconnect once more, or reschedule the remainder of our session.
What are your rights about the personal information you have shared with us? You are entitled to view, amend, or delete the personal information that we hold. Email your request to our data protection officer Amy Armstrong at amy@amyarmstrongcoaching.com.
How do we keep your information safe? We have appropriate technical and physical security measures to protect your personal information against accidental loss, damage, destruction or unauthorised processing.
Changes to this Privacy Notice. This policy was updated on 21 April 2020. It will be reviewed on an annual basis.
QA Solutions (Associates) Ltd trading as The Executive Alchemist. Registered Office: 94 Kings Drive, Bristol BS7 8JH. Registered in England No: 09381757