Informed Consent


Please write your name in the first space provided, then sign and write the date below to indicate that you understand what you have read.

I,___________________________________, agree to engage in the process of non-therapeutic hypnosis. I understand that I will have all the choices at all times and can start or end the process at anytime, even during my session.

Declaration & Disclaimer

My services as a coach and Hypnotist rendered are non-therapeutic. Best defined as the learning of the working of the mind to induce, relaxation, positive thinking, create commitment to behavior change and to learn the techniques of self-hypnosis to create awareness and self-control over emotional and physical experiences. My services ARE NOT a form of health care or psychotherapy and  ARE NOT eligible for healthcare benefit claims.

Hypnotherapy is not a substitute for professional medical care as prescribed by a qualified medical doctor.

The methods of hypnosis include relaxation, breath work, creative visualization, positive suggestions, positive affirmations, self-awareness development and other techniques and may produce emotional and physical responses. Incase of any form of concerns, fears, unease or discomfort please inform me prior to a session.

I agree to inform my hypnotist of any adverse feelings or experiences related to this process, at the time of my awareness of them.

I am over age 18, and consent to hypnosis services offered by Alexander Douglas Gacheru

Full Names:______________________________________________________________



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