YOUR RIGHTS AND RESPONSIBILITIES AS A CLIENT

Contact Information: David Gruben CHt, operating as FRMS Hypnosis, 12 Clark Lane in Waterford CT.  I also maintain a practice over Skype.

Education and Training:  I received my training through the National Guild of Hypnotists, through which I am certified, as well as a member in good standing.  I do annual continuing education. I am experienced in sports hypnosis, stress management, stop smoking and weight management, among others.  I can teach self-hypnosis, emergency hypnosis and work in forensics. (I am available to work with police to help witnesses to crime improve their memory recall.)

Notice:

    • The State of Connecticut has not adopted any educational and training standards for the practice of hypnotism.
    • Hypnotism is a self-regulating profession and State of Connecticut has does not license its practitioners. (We are required to register.)
    • I am neither a physician nor a licensed health care provider and can not provide a medical diagnosis nor recommend discontinuance of medically prescribed treatment or treatments.
    • If you as a client desire a diagnosis or any other type of treatment from a different practitioner, you may seek other services at any time.
    • In the event my services are terminated by you the client, you have the right to coordinate the transfer of services to another practitioner.
    • You as client have the right to refuse hypnotism services at any time.
    • You may assert any of these rights at any time without retaliation.

    Redress: If you ever have a complaint about my services or behavior that I cannot resolve for you personally, you may contact the National Guild of Hypnotists at P.O Box 308, Merrimack, NH 03054-0308, (603) 429-9438, to seek redress.

    Other services besides than my own may be available to you within the community. You may locate such providers in the phone book.

    Independent Agent: I am not an employee, agent, apparent agent or servant of any hospital or similar medical institution. I am an independent contractor. I am not compensated by any hospital or any referring medical professional.

    I maintain a private practice with my own professional liability and malpractice insurance. I alone have full responsibility for all applicable withholding taxes for all compensation and for compliance with any applicable state and federal regulations with respect to my self-employment.

    Fees: Fees will be agreed with you after the first initial free consultation.  Generally there is a military and first responder discount as well as a Hospital Patients Special discount.

    Confidentiality: I will not release any information to anyone without written authorization from you, except as provided by law. You have a right to be allowed access to all my written records about you. 

    Because I am neither a physician nor a licensed health care provider, there is no patient confidentiality that I can invoke.

    Insurance: I suggest you think of my services as something that you will pay for personally. That will both protect your privacy and help you value the work you are doing more. In general, insurance companies do not cover hypnotic services, and I caution you not to expect them to do so. 

    You may find that hypnosis is reimbursable through health care flexible spending account that you may have through your place of work.  It may be that you will need a doctor note.  It is your responsibility to recover monies from health care flexible spending account.  Please see http://www.fsafeds.com.

    My Approach: I believe that through hypnotism and my additional training I can help you as my client to tap into your own beliefs and help you to achieve a more positive understanding of yourself, and displace many of the previous beliefs, feelings, sensations, attitudes about yourself that are counter-productive.

    By signing below you acknowledge receipt and that you have read through this form.

    Client’s Name: ________________________________________________________

    Client’s Signature: ____________________________________________________

    Date: ________________________________________________________________

     



Success with hypnosis is dependent on many variables, including your attitude as a client, your follow-through, your adherence to the program, and your personal health and history. Please consult your physician before beginning any health program.

A consulting hypnotist can and will teach you techniques that can help you manage the everyday, ordinary problems we all have. FRMS Hypnosis does not diagnose, treat, or prescribe for any psychological or medical disorders. If you suffer from a psychological or medical disorder, please consult your physician or mental-healthcare professional.