Thank you for taking the time to complete this form. Your Name (required) Your Address (required) Your Email (required) Phone Number Your Date of Birth (required) I understand that I will be given an explanation of the Solution Focused Hypnotherapy process. If I do not understand this or have any concerns I will ask Kate for clarity. I understand that I will need to listen to the sleep hypnosis audio every night as I go to sleep to enhance the success of the sessions and achieve the best results. Although my ‘belief’ in my ability to change is not so important, I understand that the success of hypnotherapy is linked to my commitment to the sessions and to my ‘wanting’ to change. I understand that I must commit to my sequential sessions as arranged as cancelling or rescheduling will not provide the best results for me. I accept the fee payable (£60) and accept the full cancellation fee of £60 if I am unable to allow 24 hours notice of a cancellation or non-attendance. The cancellation fee will be waived if cancellation is due to the client, or any person in their household, showing symptoms of COVID-19, needing to self isolate on the advice of medical personnel or having tested positive for COVID-19. In these circumstances appointments may be offered online or rescheduled for at least 2 weeks later. I understand that should Kate, or any person in her household, show symptoms of COVID-19, need to self isolate on the advice of medical personnel, or test positive for COVID-19, my appointment will be cancelled as soon as is reasonably possible. In these circumstances appointments may be offered online or rescheduled for at least 2 weeks later. In these circumstances I understand my contact details may be passed on to the government ‘track and trace’ system. If Kate is unwell and unable to contact me herself, she will pass my contact details ONLY onto a fellow practitioner, bound by the same code of ethics and confidentiality who will contact me to cancel my appointment. Should I feel my appointment is urgent, Kate will refer me to another practitioner in her absence. I understand that my details may be used for marketing purposes by Swift Hypnotherapy, such as occasional emails containing links to free resources, special offers etc. Clients are able to unsubscribe from emails at any time. At no point will Swift Hypnotherapy make my details available to 3rd parties. I hereby consent to receiving Solution Focused Hypnotherapy (including the initial consultation) from Kate Mitchell (Swift Hypnotherapy) in accordance to the therapy agreement provided above. Today's date: (required) By clicking on the submit button below you agree to the above statements.