CLIENT BILL OF RIGHTS/DISCLOSURE STATEMENT :
Diane Ulicsni C.C.ht, C.T.T.
Notice: The State of Oregon has not adopted education and training standards for the practice of hypnosis,eft, tlt or nlp, emdr or brainspotting. This statement of credentials is for information purposes only. Under Oregon Law a hypnotherapist may not provide medical diagnosis or recommend discontinuance of medically prescribed treatments.
If a Client desires diagnosis or any other type of treatment from a different practitioner, the client will seek such services at any time and discontinue these services without further commitment. If an office r zoom visit has been scheduled, a 24 HOUR cancellation notice is required in order not to be charged the full hourly office or zoom meeting rate.
I agree to pay Diane Ulicsni or D. Ulicsni Consulting LLC a fee of $200.00 per clinical hour for the coaching either in office or via zoom. When you schedule an appointment, please understand that this time is reserved just for you. Cancellations require at least a 24 hour notice, or you agree to pay for the scheduled session or sessions. I acknowledge that Diane Ulicsni or D Ulicsni Consulting LLC is not involved in treatment or diagnosis of diseases nor does she, or anything she does substitute for medical treatment when such attention is needed, desired or required. I understand she does not treat or diagnose any illness or other physical or mental disorder. I understand that Diane Ulicsni is NOT a licensed medic, doctor, psychologist or psychiatrist.
MY APPROACH: I believe that happiness, success and change occur and are best approached at the unconscious level. All of the techniques I use including, Guided Imagery, Hypnosis, NLP (neuro-linguistics), EFT, (emotional freedom techniques, self administered EMDR, eye movement desensitization and reprocessing, Brainspotting CRM, comprehensive resource modeling or imagery, are to effect change at the unconscious level.
The Client understands that success using the above mentioned techniques is dependent on many variables, including, attitude, cooperation, practice and attendance of scheduled sessions. The Client Understands that personal results vary and that human behavior cannot be ethically warranted. The Client also understands that some mental processes used can bring up unconscious memories, images or metaphors.
The services rendered by Diane Ulicsni are to help the public as a form of success, happiness, motivational and change coaching, combined with instructions in self-hypnosis and other self-regulation techniques. Diane Ulicsni does not represent herself or her services as any form of health care of psychotherapy, and despite scientific evidence to the contrary, makes no claim of the psychological benefit for her services.
Redress: Diane Ulicsni is a Certified Member and Instructor for the National Guild of Hypnotists and adheres to the practices in accordance with its Code of Ethics and Standards. Address: PO Box 308 Merrimack, NH. 03054
I have received a copy of this disclosure and by signing, attest that I have read and understand the information provided.