Client Intake & Consent Agreement – Candid Coaching Co./Candid Hypnotherapy
THIS FORM MUST BE ELECTRONICALLY SIGNED BEFORE YOUR FIRST SESSION WITH CANDACE DWORAK CHt BY CLICKING THE ACKNOWLEDGMENT BUTTON BELOW.
CLIENT NAME:
(the "Client")

CONTRACTOR NAME:
Candace Dworak CHt
Candid Hypnotherapy
Candid Coaching Co.
candidhypnotherapy@gmail.com

(the "Contractor")
Purpose of Services

Hypnosis sessions are designed to support relaxation, personal growth, and self-awareness. Services are provided solely for vocational or avocational self-improvement. I am not a medical provider and do not diagnose, treat, or cure medical or psychological conditions. Hypnosis is not a substitute for medical or mental health care. 

Session Length 

Sessions may vary from 30 minutes to 120 minutes or more, depending on individual needs. 

Payment, Refunds, Rescheduling, and No-Shows
Payment is required in full before each session.
All sales are final. 
No refunds.
Clients may reschedule a booked session with at least 24 hours’ notice, up to two times per session purchased. Failure to attend without 24 hours’ notice will be considered a no-show. After two no-shows, the session fee will be forfeited and must be repaid in order to continue services. 

Session Expiration

All purchased sessions or packages must be used within one year of purchase date. After one year, unused sessions are forfeited and may be donated to support individuals in financial need of services. 

Eligibility and Safety

I cannot work with clients diagnosed with schizophrenia, untreated psychosis, or active suicidal ideation. Clients with diagnosed conditions such as bipolar disorder, PTSD, or severe depression must provide written approval from their treating medical or mental health professional before beginning sessions. Clients must not attend sessions under the influence of alcohol, recreational drugs, or intoxicating substances. If, during intake or sessions, I believe hypnosis is not appropriate, I reserve the right to decline or discontinue services and may recommend referral to another professional. 

Confidentiality 

Session details are kept confidential, except as required by law. 
Exceptions include:
If you disclose intent to harm yourself or others. 
If you disclose abuse that I am legally obligated to report. 

Emergencies

I am not an emergency service provider. If you are in crisis, call 911 or go to the nearest emergency room. In the U.S., you may also call or text 988 for mental health crisis support. 

Termination of Services

Either you or I may end the client–practitioner relationship at any time, without obligation to provide a detailed explanation. 

Results

There are no guarantees of outcome. I commit to using my best skills and abilities to support your goals, but results will vary by individual. 

Acknowledgment of Understanding

By signing below, you acknowledge and agree that: 
You understand the purpose and limitations of hypnosis services.
You understand and agree to the payment, cancellation, rescheduling, and expiration policies.
You understand confidentiality limits and emergency procedures.
You voluntarily consent to participate in hypnosis sessions.

Book Your First Hypnotherapy Session

Book your first hypnotherapy session with Candace Dworak CHt by filling out the acknowledgement form and booking your time slot. The first session will be 90-120 minutes long. Please plan accordingly.
Agree To Terms*

Amount to be charged:

Payment Info

First Private Hypnotherapy Session - Referral Client

2 hours
On Zoom

Select a Date and Time

Sun
Mon
Tue
Wed
Thu
Fri
Sat
Time Zone
UTC
Be submitting my email, I agree to receive periodic emails from CandidHypnotherapy@gmail.com or Candace@DanandCan.com. I will never sell your information. By submitting my phone number, I agree to receive periodic texts from Candid Hypnotherapy or Candid Coaching Co. I will NEVER sell your information.