The client will be treated with respect and care at all times. The intake form which the client fills in before the session is to assure I, Rima Jalba, can best serve the client taking into consideration various factors that contribute to the safety and success of the session.
Disclosure of all information during therapy and consultations remains confidential unless there is a risk of harm to yourself or others. Please be aware that occasionally I use anonymized material from client sessions in teaching materials, personal statistics, and content/publications. Also, I may discuss your case (maintaining your anonymity) with other qualified mental health practitioners, as part of the regular supervision which is part of my commitment to regular supervision and continuous professional development.
I will not identify you in these supervision sessions.
It is advised that you consult your doctor before having complementary therapy, including hypnotherapy. As with any practice of medicine, please be reminded that when it comes to hypnosis results may vary from person to person.
Like the practice of medicine, Hypnotherapy, and RTT are not absolute sciences. I personally know of no case on record where an individual has been harmed by the use of these methods. I do know of thousands of cases where people of all walks of life have benefited greatly from the use of these methods.
1. The practitioner has explained the session plan to my understanding (what is hypnosis, RTT, coaching).
2. Respect for the client and therapist will be constantly maintained.
3. I understand that for the sessions involving hypnosis (RTT) I will need to listen to the personalized MP3 recording and to consider the content of the sessions in order to enhance the success of the treatment.
4. I accept the fee payable for the session and note that at least 48 hours’ notice is required if an appointment needs to be rearranged, to avoid a cancellation charge of 50% (if it’s less than 48h before the session) - and a 100% cancellation charge if it’s less than 24 hours before the session.
5. I explicitly consent to you creating and storing records concerning my RTT/coaching sessions, as per your Privacy Notice, a copy of which I have seen.
6. I declare that the information provided is entirely correct and that on the basis of the given information, which also includes my medical history, the session will be carried out.
7. By signing this form, I consent that Rima Jalba may release information to a specific individual or agency if it has been determined that a child or elder is at risk of or is currently being abused; if I, as a client, am in imminent danger to myself or others; or if a subpoena of records has been requested.
8. I also understand that, at any time, Rima Jalba may discuss aspects of my case with other colleagues keeping my identity & full name anonymous, unless I give permission for it to be used otherwise.
9. I agree to pay for the session at least 48h before my session.
10. I am of legal age, and in consideration of my acceptance as a participant in this Private Coaching/ RTT session, I hereby release and discharge Rima Jalba from all claims of damages arising from, or growing out of my participation in the session(s).
I have read the agreement above and accept the treatment on these terms.
Signed: ________________________________ Date: _____________________
Print Name: _____________________________________________________________
For the purposes of promoting self-development and wellbeing, Rimarkable would like to stay in touch with you with information that may be of interest to you. Occasionally, I send out to my clients and subscribers new links to upcoming free webinars, programs, tools, resources, and tracks to improve their wellbeing.
Post Signed: ________________________________ Date: _____________________