Contact Information: My name is Joseph Packard. I can always be contacted through my office at 37 Monique Drive, Bellingham, MA 02019 or by telephone at 508-478-8500. My e-mail is email@example.com . As I am often with clients, returning telephone calls is difficult; I will make every effort to get to you as soon as possible.
Education and Training: My highest degree is a Masters of Science degree (M.Ed.) from the University of Maine. My degree is in the field of Adult Education and is accredited by an agency recognized by the United States Department of Education.
I was trained in hypnosis at Choices, Peak Performance Center. I am a Board Certified Hypnotist (BCH) by the National Guild of Hypnotists and I do annual continuing education to maintain my level of training at a high level.
Notice: THE STATE OF MASSACHUSETTS HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Under Massachusetts law a hypnotherapist may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis or any other type of treatment from a different practitioner, the client may seek such services at any time. A client has a right to be free of physical, verbal, or sexual abuse. A client has the right to know the expected duration of treatment, and may assert any right without retaliation.
Redress: I am a BCH member of the National Guild of Hypnotists, and practice in accordance with its Code of Ethics and Standards. 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 PO Box 308, Merrimack, N.H. 03054-0308, (603) 429-9438 to seek redress. Other services than my own may be available to you in the community. You may locate such providers in the telephone book.
Payment: I accept cash or a check. I am also willing to hold a post-dated check for up to two weeks if that is helpful. I am not able to extend credit. The fee for private sessions is $125 per hour. Most issues average 5 sessions. You will be given 30 days notice of any changes in fees.
Missed Sessions: Except for cases of medical, family or personal emergency, I charge for all appointments cancelled on less than 24 hours notice and not rescheduled for the same calendar week. I will also charge if you do not show for a scheduled appointment.
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. However, upon request I will supply a receipt for you to submit for reimbursement. Be aware that less than 10% of insurance companies cover hypnosis.
My Approach: I give a free consultation to any new client. Before any hypnosis takes place I like to spend time with client explaining what hypnosis is and what it is not. It is very important to dispel misconceptions and have the client looking forward to the session. As I do not independently work with mental disease, my work is considered non-therapeutic as it aims to help normal people harness their unconscious wisdom, learn to make their own right decisions and get in touch with their own healing power. On referral from your physician I also offer a most powerful and sophisticated form of complementary medical hypnotism.
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 my written record about you.
Client Signature: I have received and have read this Client Bill of Rights and understand what I have read.
Client Name (print): ___________________________________________________
Client Signature: __________________________________ Date: ______________
Parent / Guardian
Signature: _______________________________________ Date: _______________
(Parent signature is required if client is under 18 years old)