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Consent Parent or Guardian
Rob Sanderson
2023-12-29T12:04:04+00:00
Solution Focused Hypnotherapy for Minors
Parent or Guardian Consent form:
Parent/Guardian Details
Name
*
Relationship to client?
*
Email
*
Phone
*
Address
*
Child Details
Name
*
Date of birth
*
Doctors Name (if known)
Practice name
*
Practice and Address
*
Are they on any medication?
*
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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