Please note that Monique Chávez, MHt is a certified Master Hypnotherapist (MHt), Reiki Master/Teacher, and Soul Guide & Coach, and that she is NOT a medical doctor (physician, psychiatrist, psychologist, etc.) and makes no claim to diagnose or offer treatment of disease.  Furthermore, I understand that hypnosis, energy work, and/or coaching is NOT a replacement for medical treatment, psychological/psychiatric services, or counseling.  I also understand that Monique does not treat or diagnose any condition. I understand that testimonials presented from previous clients are not a promise or guarantee of results or outcome.  I understand that each person is unique and that my actual results will vary.

I also understand that, while Monique has my best interests in mind and will offer her guidance where asked, I am responsible for my own well-being and decision making.  I also understand that I am responsible for my own interpretations of and reactions to the information presented to me.  I understand that the experience of hypnosis, energy work and/or coaching is meant to present information that may contribute to mind, body, and spiritual balance and that Monique is not responsible or liable for the information I receive during the session.  I also understand that Monique is not responsible for my interpretations of the information or the decisions I make based on the information.  I understand that I am responsible for my own judgment and that all participation, interpretations, and decisions are my own.

I understand there are some conditions for which hypnosis may not be a good fit for the client.  These conditions include (and are not limited to): Schizophrenia, pathological personalities, psychosis (including substance induced), senility, dementia, brain trauma, cognitive deficiencies, epilepsy, narcolepsy, bi-polar, clinical depression, suicidal tendencies, serious heart conditions, extremely high/low blood pressure, elderly/frail, substance abuse, and/or currently taking medications/substances that cause drowsiness.  I understand that if I am, in any way, unsure if hypnosis would be a good fit for me, that it is best to consult my medical doctor prior to participating in hypnosis.  Also, if pregnant (especially in the first or second trimester), I will also consult my medical doctor prior to participating in hypnosis. 

I understand that I am accepting full responsibility for monitoring my health for this and any future group and/or individual sessions. Should the aforementioned conditions present themselves in the future, I understand and agree that I shall not participate in future sessions without first consulting with and receiving expressed consent from my health care provider.

Consent for Hypnosis:

I understand that hypnosis can involve the use of techniques such as progressive relaxation, meditation, guided imagery, as well as other helpful methods.  As a part of hypnosis, clients are encouraged to recall events, circumstances, behaviors, thoughts, and feelings from prior situations in their life experience.  I understand that clients vary greatly in their response to the relaxation and hypnotic process, with some clients having powerful experiences and others experiencing relatively little.  Additionally, I am aware that the experiences during hypnosis may be a combination of real and/or imagined.  I also understand that certain memories/experiences may invoke emotional reactions. These emotionally charged experiences are oftentimes useful for facilitating insight and understanding; however, such powerful experiences can nonetheless be emotionally challenging for some clients.

I also understand that during in-person sessions, my practitioner may gently touch me on the forehead, shoulder, and/or wrist as an anchoring/focus technique and that Monique will get my verbal consent prior to each touch. 

I have reviewed the above paragraphs, understand the principal characteristics of hypnosis, and agree to participate in this procedure.  Furthermore, I understand that if at any time I become uncomfortable and/or unwilling to proceed with the hypnosis process, that I can request to stop the process and the hypnotic portion of the session will cease immediately.