Code of Care Agreement

Code of Care:
  • All information provided by the customer to Polly Evans hypnotherapy will remain confidential and all records will be stored in a way that is compliant with the General Data Protection Regulations (2018).
  • As a customer of Polly Evans hypnotherapy, I will be provided with a copy of the Privacy Policy and be made aware of where to find an electronic version.
  • Polly Evans, in her capacity as a hypnotherapist, has a professional obligation to report concerns to relevant authorities if it is apparent that the customer may be intending to cause harm to themselves, the therapist, or others.
  • Any physical symptoms which the customer is experiencing should be discussed with their GP.
  • Hypnotherapy can ease the symptoms of many medical conditions, we make no claim to be able to ‘cure’ conditions.
  • A full copy of The Association for Solution Focused Hypnotherapy’s Code of Practice is available online. This Code generally complies with that of the CNCH, a Department of Health supported Register which Polly Evans will be registered with upon full completion of her qualification. 
Treatment Consent:
  • The therapist has fully explained the procedures and treatment.
  • I understand that I will need to listen to the relaxation soundtrack on a regular basis and to consider the content of the sessions, in order to enhance the success of the treatment.
  • Although my belief in my ability to change is not so important, I do understand that the success of the treatment is linked to my desire to change and therefore my commitment to attending sessions regularly.
  • I accept the fee which has been quoted to me and note that 24 hours notice of cancellation of an appointment is required to avoid a fee being charged. (One / two missed appointments no charge three onwards £25).
  • I accept that any fees paid in advance are not normally refundable.
  • I understand that if I arrive late for an appointment, the session may have to be shortened.
  • Mutual respect between the customer and the therapist will be constantly maintained.
  • I understand that due to the trance work being online and at my home I may fall asleep through trance work. If I am worried about sleeping over I have set an alarm for 75 minutes after appointment start time to wake me up.

Please provide an emergency contact telephone number in the form below. This will be discussed with Polly and up to me if she will call if I happen to fall into deep trance/sleep. I am aware that this is put in place as a safety aspect as Polly isn’t in the room with me. I will also make sure I am in a comfortable and safe place to carry out the session.


Customer Agreement