Client Bill of Rights

Contact Information: My name is Gary Cole. I can be contacted through my office at 701 S. Rte. 73 Ste. D, West Berlin 08091, OceanPinesHypnosis@gmail.com, or by telephone at (856) 650 -7335.

Education and Training: I was trained in hypnotism at Academy of Professional Hypnosis a curriculum approved by the New Jersey State Department of Education. I am a certified Member of the National Guild of Hypnotist and I do annual continuing education to maintain my training at a high level. The National Guild of Hypnotist is the oldest and largest hypnotism organization in the world and its certification is the most widely recognized credential for the professional practice of the hypnotic arts. My bachelor's degree is in the field of engineering and is accredited by an agency recognized by the United States Department of Education.

Notice: AS THE STATE OF NEW JERSEY HAS NOT ADOPTED EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM, THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Hypnotism is a self-regulating profession and its practitioners are not licensed by state governments. I am neither a physician nor a licensed health care provider and may not provide a medical diagnosis nor 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. In the event my services are terminated by a client, the client has the right to coordinated transfer of services to another practitioner. A client has a right to refuse hypnotism services at any time. A client has a right to be free of physical, verbal or sexual abuse. A client has a right to know the expected duration of sessions, may assert any right without retaliation.

Redress: I am a certified member of the National Guild of Hypnotist, and practice in accordance with its Code of Ethics and Standards. If you have a complaint about my services or behavior that I cannot resolve for you personally, you may contact the National Guild of Hypnotist at P.O Box 308, Merrimack, NH 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 on the internet.

Fees: The charge for my services is fifty dollars per hour. You will be given 30 days' notice of any change in fees. I do not take insurance payments. I take checks, debit card swipes and credit card payments. Please give me 24 hours' notice if you cannot make our scheduled meeting.

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

Insurance: I suggest you think of my services as something that you 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.

My Approach: You have two active minds: your conscious and your unconscious. The conscious mind is what gives you identity and purpose. The unconscious mind usually executes your actions to support your conscious mind. Sometimes the unconscious strategies are at odds with the conscious identity and purpose. Hypnotism is a way to communicate to the unconscious mind strategies and methods consistent with the conscious minds purposes and I help the conscious mind see or hear solutions the unconscious mind is presenting.

Client Signature: I have received and read this Client Bill of Rights and understand what I have read.

Print Client Name: ____________________________Client Signature: ________________________ Date