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Consent Form
Rob Sanderson
2023-09-06T08:43:30+00:00
Consent to Receive Solution Focused Hypnotherapy
Your Details
Name
*
Age
*
Email
*
Phone
*
Address
*
GP Details
Doctors Name (if known)
Practice name
*
Practice and Address
*
Have you been prescribed medication?
Yes, and taking
Yes, but not taking
No
What prescribed medication are you taking?
*
What medication have you been prescribed and not taking?
*
Permission to inform your GP?
*
Yes
no
I don't generally contact GP's and don't share information or details with them. However, with some conditions or medications, it's a professional courtesy for me to inform your GP you are having hypnotherapy.
Not compulsory.
I hereby consent to receive Solution Focused Hypnotherapy from Rob Sanderson HPD DSFH SF Sup (Hyp).
Clinical Hypnotherapist, Psychotherapist, Senior Lecturer and Supervisor. Regulated by the AfSFH and NCH.
Date
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