Terms of Service & Release Statement
THE STATE OF NEW JERSEY HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY.
Under New Jersey Law, a hypnotist may not provide a medical diagnosis or 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 a right to coordinated transfer of services to another practitioner. A client has a right to refuse hypnosis 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 treatment, and may assert any right without retaliation.
Your Right to File a Complaint: All hypnotists are supervised by Brian Eslick. Clients may expect courteous treatment free from verbal, physical or sexual abuse by the practitioner. If you have any questions or complaints regarding any of our practitioners, please contact our office and speak directly to Mr. Eslick, at the address or telephone number listed above. If you have a complaint about our services or behavior that Mr. Eslick cannot resolve for you personally, you may contact the National Guild of Hypnotists at P.O. Box 308, Merrimack, NH 03054-0308, (603) 429-9438, to seek redress. Other services then our own may be available to you in the community and you may locate them in the telephone book.
Fees and Billing: Fees for seeing a hypnotist for individual sessions at are based upon a standard session rate of $175.00 per session, though packaged pricing may be offered. Special programs like Stop Smoking are at a higher program rate of $600. Clients must give 24 hours’ notice for changing appointments or canceling appointments, or they will forfeit the appointment or pay a $50.00 rescheduling fee. Clients have the right to reasonable notice of changes in services or charges. You have the right to freely seek services elsewhere at any time. We can also make specific referrals if requested. You have the right to coordinate transfer of services in the case of change of service provider. You always have the right to refuse services or treatment unless otherwise provided by law. You may assert any client’s rights listed here without retaliation.
Insurance: We do not bill insurance companies for services, however some insurance companies may reimburse you for services. Check with your insurance company or policy for additional details. We suggest you think of our services as something that you will pay for personally. That will both protect your privacy and help you value the work you are doing more.
Theoretical Approach: The practitioners utilize hypnotic techniques and instruction to help clients make changes both consciously and subconsciously. Techniques include but are not limited to hypnosis, self-hypnosis instruction, relaxation training, visualization, instructional handouts, audio supplements, and videos.
Assessment and Duration of Treatment: You have the right to view your client file, including any notes or assessments made (additional fees may occur if taken outside of your regular scheduled time with the hypnotist). Hypnosis is a brief intervention process. It is difficult to predict the number of sessions you will require to resolve your issue, though an ethical assessment is done in the initial call and a plan is set from there.
Your Process Is Confidential: Client records and transactions with the practitioner are confidential, and may only be viewed by staff, unless release of these records is authorized in writing by the client, or otherwise provided by law.
I understand that Brian Eslick, BCH is not a Physician, does not practice medicine, and does not diagnose or treat any medical condition. I affirm that I am not currently being treated for any medical condition related to my requested behavior modification program. Hypnosis can be used as a complementary care to most medical conditions, however a referral from your physician for pain control or licensed mental health counselor is required if requesting this type of hypnosis treatment. I understand hypnosis does not constitute Psychiatric treatment, Psychotherapy or Psychoanalysis.
I also understand that hypnosis is not a replacement for traditional medical or mental treatment and should not be used as such. I understand that Hypnosis is not a replacement for my family doctors care nor is it to be used for, or is it a replacement for any medications, diagnosis or treatment of a licensed medical doctor.
I hereby authorize Brian Eslick to hypnotize me for the concerns we have discussed and/or that I have indicated on my intake form. I give Brian Eslick permission to use hypnosis for any issues that have been outlined in my intake form and for any future purposes that I may request.
I understand that the success of my hypnosis sessions depends greatly on my own ability and desire to affect change in myself and the results depend greatly on my own serious participation and follow through. I understand that although hypnosis can be very effective and has a high success rate, Brian Eslick and New Jersey Family Hypnosis does not offer a guarantee, as my own personal success depends on my own ability and desire to create change in myself.
I am aware and understand that in some cases it may be necessary for the practitioner to respectfully touch my shoulder(s), hand, wrist, or forehead in order to assist me in relaxation. I give the practitioner permission and consent to do so in order to help me establish a beneficial state of hypnosis.
It is understood that I will immediately discontinue the use of hypnotherapy, if directed by my physician.
I understand that matters discussed during a session will be keep confidential except in the following circumstances: I sign a release of information giving permission to release information to a specific individual or agency; child abuse; client is in imminent danger to self or others; subpoena of records. In addition, Brian Eslick may from time to time discuss aspects of my case with other colleagues (the client would not be identified by name) who will likewise maintain confidentiality.
I understand that there is a strictly enforced 24 Hour Cancellation Policy and I agree to pay in full should I cancel an appointment within 24 hours.
I understand there are no refunds only session credit.
Personal, dedicated and professional
5 E. Union Ave. Bound Brook, NJ 08805
New Jersey Family Hypnosis does not practice medicine, and does not diagnose or treat any medical condition. Hypnosis does not constitute Psychiatric treatment, Psychotherapy or Psychoanalysis. Hypnosis is self-help. Understand that the success of hypnosis depends greatly on own ability and desire to affect change in self, the results depend greatly on own serious participation and follow through. We do not offer a guarantee nor a refund.