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Hypnotherapy Client Intake Form

Hypnotherapy Client Intake Form Template for Ireland

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Hypnotherapy Client Intake Form

"I need a Hypnotherapy Client Intake Form for my Dublin-based online practice launching in January 2025, with strong emphasis on GDPR compliance and digital signature capabilities for remote clients."

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Document background
The Hypnotherapy Client Intake Form is a foundational document used in Irish hypnotherapy practices for new client onboarding and assessment. It is designed to gather comprehensive information about the client's medical history, current health status, and treatment goals while ensuring compliance with Irish healthcare regulations and EU data protection laws. This document should be used before commencing any hypnotherapy treatment to establish the therapeutic relationship, document informed consent, and identify any contraindications or risks. The form serves multiple purposes including legal protection, clinical assessment, and maintaining professional standards in accordance with Irish healthcare practices. It is essential for creating a clear record of the client's condition and their agreement to treatment terms.
Suggested Sections

1. Personal Information: Client's basic details including name, contact information, age, occupation, and emergency contact details

2. Medical History: Current and past medical conditions, medications, treatments, and relevant health professional contacts

3. Mental Health History: Previous mental health treatments, diagnoses, and current mental health status

4. Presenting Issues: Primary reasons for seeking hypnotherapy and specific goals or outcomes desired

5. Previous Therapy Experience: History of any previous hypnotherapy or other therapeutic interventions

6. Risk Assessment: Screening for contraindications and potential risks

7. Informed Consent: Detailed explanation of hypnotherapy process, risks, and client rights

8. Data Protection Notice: GDPR-compliant explanation of how personal data will be collected, used, and protected

9. Payment and Cancellation Policy: Clear terms regarding fees, payment methods, and cancellation policies

10. Declaration and Signature: Client acknowledgment and agreement to all terms and conditions

Optional Sections

1. Pregnancy Status: Required when working with pregnant clients or those trying to conceive

2. Pain Management: Additional section for clients seeking hypnotherapy for chronic pain or medical conditions

3. Addiction History: Detailed section for clients seeking help with addiction-related issues

4. Weight Management: Specific section for clients seeking weight loss or eating behavior modification

5. Performance Enhancement: Section for clients seeking sports or professional performance improvement

6. Phobia Assessment: Detailed section for clients seeking help with specific phobias

Suggested Schedules

1. Privacy Policy: Detailed GDPR-compliant privacy policy explaining data handling practices

2. Medical Questionnaire: Comprehensive health assessment form for detailed medical history

3. Treatment Agreement: Detailed terms and conditions of hypnotherapy services

4. Emergency Protocols: Procedures for handling emergencies during sessions

5. Recording Consent Form: Optional consent form for session recording if applicable

6. Progress Tracking Sheet: Template for monitoring client progress across sessions

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈË°æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions






























Clauses




















Relevant Industries

Healthcare

Mental Health

Alternative Medicine

Wellness and Lifestyle

Complementary Therapy

Professional Services

Medical Practice Management

Relevant Teams

Legal

Compliance

Medical Records

Client Services

Administration

Clinical Operations

Quality Assurance

Data Protection

Healthcare Operations

Patient Relations

Relevant Roles

Hypnotherapist

Clinical Hypnotherapist

Mental Health Professional

Wellness Practitioner

Practice Manager

Medical Records Administrator

Compliance Officer

Healthcare Administrator

Client Services Coordinator

Alternative Medicine Practitioner

Therapy Practice Owner

Industries






Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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