+ I realize that my success depends on my own commitment to improving the situation that brings me here. I acknowledge that the hypnotherapist is not diagnosing, prescribing for, or treating any physical or mental ailments, and I do not hold the hypnotherapist responsible for them.

+ I release the hypnotherapist from any liability whatsoever regarding my hypnotherapy session. Any conclusions I draw from my session or responses I have are mine and mine alone. I take full and total responsibility.

+ I understand that these sessions are not psychotherapy but are a therapeutic alternative aimed at creating positive changes in my life.

Hypnotherapy is a highly effective healing modality for most people. For some, it may be intense, and inner material may come up both in and after sessions. This is actually a healing experience when properly understood. The best action to take is to call your hypnotherapist and get assistance. Most people find they have positive experiences.

In order to support you in deriving maximum benefit from our scheduled time together, I agree to:

Use the best of my abilities and expertise to facilitate such changes as are mutually agreed to be in your interest and in no way harmful to you;

Work diligently to ensure as best I can that all suggestions given are positive in direction, beneficial in nature, and presented within a context of health and well-being;

Refrain from using you or your trust to satisfy any personal needs I may have outside the working relationship established here;

Offer you my undivided attention and professional assistance during our scheduled consultations;

Inform you immediately if, in my judgment, you would be better served by another professional or an alternative means of reaching your objectives.

I am professionally committed to assisting you in – in the shortest possible time and at the lowest possible cost -- in mobilizing your resources to achieve the results you seek.

Sincerely,

Alicia K. Mutch, CCHt

Alicia K. Mutch, Certified Clinical Hypnotherapist (CCHt)

311 Center Street, Suite E, Healdsburg, CA 95448 | wellness@aliciamutch.com | (707) 431-1844

Certified by the National Guild of Hypnotists and the American Council of Hypnotist Examiners

In practice since 1998

The undersigned Client acknowledges that he or she has been informed of the following information:

Alicia K. Mutch, CCHt, agrees to provide professional services in accordance with acquired training and experience giving undivided attention during scheduled consultations to facilitate Client's benefits. Alicia’s work is Client-centered. Services provided utilize induction of hypnosis, and methods and principles used to help clients discover their inner creative abilities to develop positive thinking and feeling and to transform undesirable habits and behavior patterns. Therapeutic goals are to achieve freedom from restrictive thought and belief systems, to assist in solving personal problems, developing motivation and achieving goals. Client may be taught the use of self-hypnotic techniques to assist in achieving goals and resolving issues that have been mutually agreed upon by Client and Hypnotherapist.

Hypnosis is not a state of sleep, but is a natural state of mind that can produce extraordinary levels of relaxation of mind, body and emotions. The principles and theories upon which hypnotherapy is based access and utilize the power of one's inner resources. Hypnosis can transcend the critical, analytical level of mind and facilitate the acceptance of suggestions, directions and instructions desired by the Client. The therapeutic use of hypnosis can also elicit information and insights from the inner mind. The Hypnotherapist utilizes interviews, discussion and hypnotic methods dealing with underlying issues whenever appropriate, with the goal of achieving effective and lasting results.

Services to be provided do not include the practice of medicine, as the Hypnotherapist is not a licensed physician. These services are non-diagnostic, and are complementary to the healing arts services that are licensed by the state. The California State Legislature has determined that state licensing may not be conferred upon an occupational group for purposes of status or prestige. The primary purpose of licensing laws for legally defined Healing Arts and Mental Health professionals is to protect public health and safety. Accordingly, Hypnotherapists are not issued licenses by any state governmental agency to engage in their professional services.

I, Alicia K. Mutch, CCHt, have acquired the following education, training, experience, and qualifications to perform the services offered to my Clients:

1998: Institute for Therapeutic Learning (Seattle) - Jack Elias, CCHt

• 200 hours of hypnotherapy training
• Certified as a Transpersonal Clinical Hypnotherapist

2000 - 2023: HypnoBirthing® Institute - Marie Mongan, CHt

• Certified as a HypnoBirthing® Childbirth Educator
• Taught HypnoBirthing® childbirth classes for 23 years
• Maintained annual certification

2005: Center for Healing and Transformation (Oakland) - Marilyn Gordon, CHt

• 100 hours of hypnotherapy training

2010 - 2023: Hypnotherapy Training Institute (Santa Rosa) - Randal Churchill, CCHt

• 400 hours of hypnotherapy training
• Certified as a Clinical Hypnotherapist

For complaints not resolved by Hypnotherapist, contact the American Council of Hypnotist Examiners, 700 S. Central Ave., Glendale, CA 91204.