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Consent Adult Guardian
Rob Sanderson
2023-09-06T08:44:40+00:00
Consent to Receive Solution Focused Hypnotherapy
Guardian Consent form:
Guardian Details
Name
*
Relationship to client
*
Email
*
Phone
*
Address
*
Client Details
Name
*
Date of birth
*
Doctors Name (if known)
Practice name
*
Practice and Address
*
Is the client on any medication? Please list
*
I hereby consent to receive Solution Focused Hypnotherapy from Serene Hypnotherapy (Rob Sanderson/Lou Harris).
Clinical Hypnotherapists and Psychotherapists Regulated by the APHP and NCH.
Date
*
DD slash MM slash YYYY
Parent/Guardian Digital Signature
*
Click to Sign
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