The undersigned Client acknowledges that he or she has been informed of the following information:

Hypnotherapist agrees to provide professional services in accordance with acquired training and experience giving undivided attention during scheduled consultations to facilitate Client’s benefits. Hypnotherapist’s work is Client-centered. Services provided utilize induction of hypnosis and methods and principles used to help clients discover their inner creative abilities to develop positive thinking and feeling and to transform undesirable habits and behavior patterns. Therapeutic goals are to achieve freedom from restrictive thought and belief systems, to assist in solving personal problems, developing motivation and achieving goals. Client may be taught the use of self-hypnotic techniques to assist in achieving goals and resolving issues that have been mutually agreed upon by Client and Hypnotherapist.

Hypnosis is not a state of sleep, but is a natural state of mind that can produce extraordinary levels of relaxation of mind, body and emotions. The principles and theories upon which hypnotherapy are based are accessing and utilizing the power of one’s inner resources. Hypnosis can transcend the critical, analytical level of mind, and facilitate the acceptance of suggestions, directions and instructions desired by the Client. The therapeutic use of Hypnosis can also elicit information and insights from the inner mind. During hypnotherapy sessions, clients remain completely aware of everything that is going on. In fact, many people experience a hyper-awareness where sensations are perceived enriched and vivid. The ability to visualize or imagine is enhanced. Deep relaxation is common. Many describe the hypnotic state as a complete and total escape from physical tension and emotional stress, while remaining completely alert. The hypnotherapist utilizes interviews, discussion and hypnotic methods dealing with underlying issues whenever appropriate, with the goal to achieve effective and lasting results.

Services to be provided do not include the practice of medicine. These services are non-diagnostic and are complementary to the healing arts services. Katheren Caldwell is a legal Alternative Healthcare Provider and not a licensed healing arts practitioner.

The use of hypnosis could elicit memories of past events which may or may not be literally true. It is possible that events under hypnosis will be distorted or misconstrued. Memories or images evoked under hypnosis are not necessarily accurate and may be a construction or a composite of memories. Without corroborating information, it is not possible to determine whether a specific memory is true or false, even if it seems true to the client.

I, Katheren Caldwell, Certified Hypnotherapist, have acquired the following education, training, experience, and qualifications to perform the services offered to my Clients. In addition, I have fulfilled or surpassed continuing education to meet specifications for good standing of following memberships:

  • Certified by the American Institute of Hypnotherapy,
    American Board of Hypnotherapy
  • Former International Association of Clinical Hypnotherapists
  • CAMFT: California Assn. of Marriage & Family Therapists
  • CCAPP: California Consortium of Addiction Programs and Professionals
  • Certified Clinical Hypnotherapist
  • Guided Imagery Therapist
  • Interactive Imagery Guide (sm)
  • Imagery International
  • The Academy for Guided Imagery
  • Certified Alcohol & Drug Counselor, CADC-II

Complimentary Healthcare Disclosure Form in accordance with 2003 Business and Professions Code 2051, 2052, and 2053 of the State of California.