Client Informed Consent Agreement for
Hypnotherapy Sessions at Maja Healing

UPDATED ON JANUARY 15TH, 2024

Before we proceed with the hypnotherapy session, Maja Healing requires all clients to read and sign this Informed Consent Agreement. This is to ensure that you are fully informed about the procedures, risks, and potential discomforts involved in the treatments we offer.  

​

Nature of Treatment

​

During a hypnotherapy session, clients typically experience a state of deep relaxation and focused attention, facilitated by the guidance of a trained therapist. Within this therapeutic environment, you may explore subconscious thoughts, feelings, and memories that contribute to their current challenges or concerns. Through dialogue and suggestion, the therapist will help you uncover and address underlying issues, promoting self-awareness and empowerment. Hypnotherapy often targets specific goals, such as overcoming phobias, managing stress, or breaking unwanted habits. Sessions are tailored to each client's unique needs and preferences, fostering a collaborative and supportive therapeutic relationship.

​

​

Confidentiality

​

I understand that all information disclosed during sessions is strictly confidential, and there will be no recording of any kind. I also agree not to record the session in any way, shape, or form. This confidentiality agreement extends to the director of Maja Healing for supervision purposes only.

​

Limits to Services and Assumption of Risks

​

Therapy sessions carry both benefits and risks. Therapy sessions can significantly reduce the amount of distress someone is feeling, improve relationships, and/or resolve other specific issues. However, these improvements and any "cures" cannot be guaranteed for any condition due to the many variables that affect these therapy sessions.

During the therapy session, experiencing uncomfortable feelings, physical unease, and discussing unpleasant situations, memories and/or aspects of your life are considered part of the therapy session and are considered risks of the therapy session.

After the session, there is typically an integration period where uncomfortable feelings may still be felt, and/or physical discomfort and unease may occur (for example, this may include fatigue, headaches, aches, and feeling emotionally sensitive). These are also considered risks of the therapy session. The integration period will range from a minimum of 3 days to a maximum of 14 days after the session date.

​

​

How to Prepare the Session

​

• Please prepare in one or two sentences what you would like to address.

• Below this sentence, you may include more details such as when you experienced this, what tends to be the triggers, how long you have experienced this, and whatever else comes to mind. If you have several points you wish to address, please also prepare them.

• Please make sure to eat before the session as you will be requiring energy for the 3-hour time frame you will be with me.

• Prepare to be as relaxed, open, and flexible for the session.

• Please avoid the following:

1. Any coffee or strong caffeinated drinks within 2 hours of the start of the session.

2. Drinking alcohol within 12 hours of the session.

3. Any mind-altering drugs (natural and synthetic) within 12 hours of the session.
4. All hallucinogenic 4 days before the session.​

Please know that it is not in the interest of any HHHypnosis hypnotherapists to extend the number of sessions to resolve the topic. We each can do our very best in resolving the topic fully and totally in each session, though, we will only move with the flow of how your subconscious processes. This is important for your overall well-being. Finally, it may occur that we may find it necessary to address other unexpected issues first (known and unknown) before we can fully address the main topic you are looking to resolve. Therefore, please also come to the session as open as possible to explore and resolve your topic.

Potential Benefits Include and Not Limited To

• Enhanced relaxation and stress reduction. 

• Lighter emotional state.

• Clearer mental state.

• Improved quality of sleep.

​

Post-Treatment Information

​

It is important to allow yourself space and time to process the session both consciously and unconsciously on a mental, emotional, and physical level. Following the session, a typical 3 to 14 days integration period may occur during which you might experience continued effects of the treatment. These can include but are not limited to:

These can include but not limited to:

• Emotional release, such as feeling unexplained emotions, tenderness, or vulnerability.

• Unusual dreams.

• A sensation of feeling flat or empty, and/or unsettled.

• Heightened senses, creativity, joy, etc.

​Please consider the following during your post-integration period:

​

• It is highly advised to take the time to eat a good meal and drink right after the session before returning to your daily routine.

• It is highly advised to not carry out any intensive exercise routine the same day after the session. 

• If you have any other energy session planned within 7 days of the session you have booked at Maja Healing with another therapist (at Maja Healing or elsewhere), please consult with the therapist at Maja Healing if this is advisable to keep the upcoming session at Maja Healing or postpone the session following the upcoming session at  Maja Healing. 

• Drink plenty of water, rest, and practice gentle self-care during this period.  It is advised to avoid any alcohol.

• Give yourself 2-3 days to recalibrate before concluding the effects of the session.

​

Integration Phase

​

Following sessions, I understand that there may be an integration phase where I process and integrate insights gained. This may include:

• Hypnotherapy integration lasting from 3 to 14 days.​

• During this period, I may experience continued emotional processing and reflection.

​​

​

Possible Risks and Discomforts

​

I acknowledge that hypnotherapy may involve emotional, mental, spiritual, and physical discomfort. Common risks include:

• Emotional release and processing of difficult memories or emotions.

• Increased awareness of personal challenges or patterns.

• Temporary exacerbation of symptoms before improvement.

• Discomfort during the integration phase.

​

Client Consent

​

Voluntary Participation: I understand that my participation in these treatments is voluntary and that I am free to withdraw my consent and to discontinue participation at any time.

​

Health Information: I have discussed any known medical conditions or health concerns with my therapist prior to starting the treatment.

​

Communication: I agree to communicate openly with my therapist during the session about any discomfort or concerns I may have regarding the technique or the treatment.

Duration of Consent: By signing this consent form, I agree that the permissions and acknowledgments provided herein will remain in effect for one year from the date of signature. This consent will apply to all subsequent sessions during this period without requiring additional written consent, unless otherwise requested by you or updated terms are introduced by Maja Healing.

​

Comprehensive Consent Acknowledgment: By signing this consent form, I acknowledge and agree that this consent applies universally to all hypnotherapy sessions provided at Maja Healing, regardless of the type of treatment or the therapist performing the session. I understand that this agreement will govern each and every hypnotherapy session I participate in at Maja Healing.

​

Supervision: As part of our commitment to providing the highest quality of care, your case may be reviewed during supervision sessions. If deemed necessary, information about your case will be shared with our founder and director, Kartika Alexandra for further supervision and guidance. All information shared will continue to be handled with the utmost confidentiality and respect for your privacy.

​

Acknowledgment of Risks and Release of Liability: By signing this document, I acknowledge that I have been informed of the risks associated with body work sessions at Maja Healing. I hereby release Maja Healing and its therapists from all liability for any injury, loss, or damage to person or property that may arise out of, or is in any way related to, my participation in these treatments.

​​

​

Confirmation of Consent

​

By booking the the hypnotherapy session, I confirm that I have read this Informed Consent Agreement thoroughly and understand the terms. I have been given the opportunity to ask questions, and all my questions have been answered to my satisfaction.

Client Informed Consent Agreement for
Counseling Sessions at Maja Healing

UPDATED ON JANUARY 15TH, 2024
Before we proceed with the hypnotherapy session, Maja Healing requires all clients to read and sign this Informed Consent Agreement. This is to ensure that you are fully informed about the procedures, risks, and potential discomforts involved in the treatments we offer.  

​

Nature of Treatment

​

During a hypnotherapy session, clients typically experience a state of deep relaxation and focused attention, facilitated by the guidance of a trained therapist. Within this therapeutic environment, you may explore subconscious thoughts, feelings, and memories that contribute to their current challenges or concerns. Through dialogue and suggestion, the therapist will help you uncover and address underlying issues, promoting self-awareness and empowerment. Hypnotherapy often targets specific goals, such as overcoming phobias, managing stress, or breaking unwanted habits. Sessions are tailored to each client's unique needs and preferences, fostering a collaborative and supportive therapeutic relationship.

​

​

Confidentiality

​

I understand that all information disclosed during sessions is strictly confidential, and there will be no recording of any kind. I also agree not to record the session in any way, shape, or form. This confidentiality agreement extends to the director of Maja Healing for supervision purposes only.

​

Limits to Services and Assumption of Risks

​

Therapy sessions carry both benefits and risks. Therapy sessions can significantly reduce the amount of distress someone is feeling, improve relationships, and/or resolve other specific issues. However, these improvements and any "cures" cannot be guaranteed for any condition due to the many variables that affect these therapy sessions.

During the therapy session, experiencing uncomfortable feelings, physical unease, and discussing unpleasant situations, memories and/or aspects of your life are considered part of the therapy session and are considered risks of the therapy session.

After the session, there is typically an integration period where uncomfortable feelings may still be felt, and/or physical discomfort and unease may occur (for example, this may include fatigue, headaches, aches, and feeling emotionally sensitive). These are also considered risks of the therapy session. The integration period will range from a minimum of 3 days to a maximum of 14 days after the session date.

​

​

How to Prepare the Session

​

• Please prepare in one or two sentences what you would like to address.

• Below this sentence, you may include more details such as when you experienced this, what tends to be the triggers, how long you have experienced this, and whatever else comes to mind. If you have several points you wish to address, please also prepare them.

• Please make sure to eat before the session as you will be requiring energy for the 3-hour time frame you will be with me.

• Prepare to be as relaxed, open, and flexible for the session.

• Please avoid the following:

1. Any coffee or strong caffeinated drinks within 2 hours of the start of the session.

2. Drinking alcohol within 12 hours of the session.

3. Any mind-altering drugs (natural and synthetic) within 12 hours of the session.
4. All hallucinogenic 4 days before the session.​

Please know that it is not in the interest of any HHHypnosis hypnotherapists to extend the number of sessions to resolve the topic. We each can do our very best in resolving the topic fully and totally in each session, though, we will only move with the flow of how your subconscious processes. This is important for your overall well-being. Finally, it may occur that we may find it necessary to address other unexpected issues first (known and unknown) before we can fully address the main topic you are looking to resolve. Therefore, please also come to the session as open as possible to explore and resolve your topic.

Potential Benefits Include and Not Limited To

• Enhanced relaxation and stress reduction. 

• Lighter emotional state.

• Clearer mental state.

• Improved quality of sleep.

​

Post-Treatment Information

​

It is important to allow yourself space and time to process the session both consciously and unconsciously on a mental, emotional, and physical level. Following the session, a typical 3 to 14 days integration period may occur during which you might experience continued effects of the treatment. These can include but are not limited to:

These can include but not limited to:

• Emotional release, such as feeling unexplained emotions, tenderness, or vulnerability.

• Unusual dreams.

• A sensation of feeling flat or empty, and/or unsettled.

• Heightened senses, creativity, joy, etc.

​Please consider the following during your post-integration period:

​

• It is highly advised to take the time to eat a good meal and drink right after the session before returning to your daily routine.

• It is highly advised to not carry out any intensive exercise routine the same day after the session. 

• If you have any other energy session planned within 7 days of the session you have booked at Maja Healing with another therapist (at Maja Healing or elsewhere), please consult with the therapist at Maja Healing if this is advisable to keep the upcoming session at Maja Healing or postpone the session following the upcoming session at  Maja Healing. 

• Drink plenty of water, rest, and practice gentle self-care during this period.  It is advised to avoid any alcohol.

• Give yourself 2-3 days to recalibrate before concluding the effects of the session.

​

Integration Phase

​

Following sessions, I understand that there may be an integration phase where I process and integrate insights gained. This may include:

• Hypnotherapy integration lasting from 3 to 14 days.​

• During this period, I may experience continued emotional processing and reflection.

​​

​

Possible Risks and Discomforts

​

I acknowledge that hypnotherapy may involve emotional, mental, spiritual, and physical discomfort. Common risks include:

• Emotional release and processing of difficult memories or emotions.

• Increased awareness of personal challenges or patterns.

• Temporary exacerbation of symptoms before improvement.

• Discomfort during the integration phase.

​

Client Consent

​

Voluntary Participation: I understand that my participation in these treatments is voluntary and that I am free to withdraw my consent and to discontinue participation at any time.

​

Health Information: I have discussed any known medical conditions or health concerns with my therapist prior to starting the treatment.

​

Communication: I agree to communicate openly with my therapist during the session about any discomfort or concerns I may have regarding the technique or the treatment.

Duration of Consent: By signing this consent form, I agree that the permissions and acknowledgments provided herein will remain in effect for one year from the date of signature. This consent will apply to all subsequent sessions during this period without requiring additional written consent, unless otherwise requested by you or updated terms are introduced by Maja Healing.

​

Comprehensive Consent Acknowledgment: By signing this consent form, I acknowledge and agree that this consent applies universally to all hypnotherapy sessions provided at Maja Healing, regardless of the type of treatment or the therapist performing the session. I understand that this agreement will govern each and every hypnotherapy session I participate in at Maja Healing.

​

Supervision: As part of our commitment to providing the highest quality of care, your case may be reviewed during supervision sessions. If deemed necessary, information about your case will be shared with our founder and director, Kartika Alexandra for further supervision and guidance. All information shared will continue to be handled with the utmost confidentiality and respect for your privacy.

​

Acknowledgment of Risks and Release of Liability: By signing this document, I acknowledge that I have been informed of the risks associated with body work sessions at Maja Healing. I hereby release Maja Healing and its therapists from all liability for any injury, loss, or damage to person or property that may arise out of, or is in any way related to, my participation in these treatments.

​​

​

Confirmation of Consent

​

By booking the the hypnotherapy session, I confirm that I have read this Informed Consent Agreement thoroughly and understand the terms. I have been given the opportunity to ask questions, and all my questions have been answered to my satisfaction.