Professional Service Agreement

1. As a client, I understand and agree that I am fully responsible for my physical, mental and emotional well-being during my sessions, including my choices and decisions. I am aware that I can choose to discontinue attending sessions at any time.

2. I understand that “coaching and/or hypnosis or hypnotherapy" is a Professional-Client relationship I have with Leesa Poffenroth that is designed to facilitate the creation/development of personal or professional goals and/or to develop and carry out a strategy/plan for me to achieve those goals.

3. I understand that coaching and/or hypnosis or hypnotherapy is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, education and recreation. I acknowledge that deciding how to handle these issues, incorporate coaching into those areas, and implementing my choices is exclusively my responsibility.

4. I understand that coaching and/or hypnosis or hypnotherapy does not involve the diagnosis or treatment of mental disorders as defined by the Canadian Psychological, American Psychiatric Association or any other association governing or responsible for the diagnosis or treatment of mental disorders. I understand that coaching and/or hypnotherapy is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment and I will not use it in place of any form of diagnosis, treatment or therapy.

5. I promise that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with the mental health care provider regarding the advisability of working with a coach and/or hypnotherapist and that this person is aware of my decision to proceed with the coaching and/or hypnotherapy relationship.

6. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law.

7. I understand that certain topics may be anonymously and hypothetically shared with other professionals for training or consultation purposes.

8. I understand that coaching and/or hypnosis or hypnotherapy is not to be used as a substitute for professional advice by legal, medical, financial, business, religious or other qualified professionals. I will seek independent professional guidance for legal, medical, financial, business, religious or other matters. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my sole responsibility.

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9. I understand that Leesa Poffenroth is trained in several modalities and may from time to time utilize these tools, in addition to coaching and/or hypnosis or hypnotherapy, in order to help serve me better.  These may include, but are not limited to Yoga, Reiki & Breathwork. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions, my choices and my actions regarding them are my sole responsibility.

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10. I understand that Leesa Poffenroth is not a licensed therapist and that I am responsible for all my decisions, actions and feelings.

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11. I agree to pay my fees as required at the time of booking. 

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12. I have read this document. I understand my role and Leesa Poffenroth’s role in our professional relationship. I will ask questions and clarify anything I don’t understand.  I understand that 'Leesa Poffenroth' includes any reference to 'Soul Synchrony Hypnosis' as well under this agreement.

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13. I am committed to doing everything I need to do to get 100% from this professional service and reach my goals.

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14. I may choose to give Leesa Poffenroth permission to release my name, phone and email address as a client to a professional association and accrediting body if requested in writing by Leesa Poffenroth. I understand that this is not a requirement by Leesa Poffenroth and is strictly my choice. This information will be given for credentialing purposes only and will be held confidential by the requesting body.  

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15. PRIVATE SESSIONS: I may request and grant Leesa Poffenroth permission to record my sessions. This will be my choice and I will request it if I so choose. I understand that Leesa may like to record a session for learning, social media or credentialing purposes. In this case, Leesa Poffenroth will request my permission first and will only record the session if I agree in writing or verbally on the recording as we commence the session. Recordings will only be utilized as agreed upon in writing, and only those specific sections identified by me and agreed upon.

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16. ONLINE GROUP SESSIONS: I give Leesa Poffenroth permission to record online group sessions that I attend.  I understand that she may share these recordings for credentialing purposes and/or with others who have paid for these same session(s) but were unable to attend live. I also understand that she may from time to time share images or portions thereof, of the sessions for marketing and/or on social media. I understand that she will to the best of her ability and discretion ensure that no personal information of mine will be shared. If there is a powerful moment that may be helpful to others, Leesa will request my permission in writing first if it involves me directly. I further understand that group recordings in which I have attended (or not attended) that I received, will not be shared by me. 

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Furthermore

Prior History

The Named client also agrees to disclose details of the past or present psychological or psychiatric treatment. In entering into the coach and/or hypnotist or hypnotherapist relationship, and by signing the agreement, the client is agreeing that if any mental health difficulties arise during the course of the professional relationship, the client will notify Leesa Poffenroth immediately so that she can discuss with the client appropriate steps and if any additional referrals are needed.

Privacy
The client can, at any point in their session, declare their preference not to discuss a specific issue or topic, by simply stating that they would rather not discuss this issue or topic. Leesa Poffenroth agrees to respect this boundary and will not attempt to forward the conversation further along those lines.

Confidentiality
1. All information about the professional relationship will remain strictly confidential except in very rare circumstances where decreed by law; ie. where the court might issue a subpoena for the file or information.

2. If you wish for Leesa Poffenroth to speak to someone outside your interactions, then you need to give her written permission (original letter or email) to do so. Additional fees may apply.

3. Exceptions to confidentiality of course relate to circumstances such as intent to seriously harm someone, child abuse etc. Otherwise, all your information is confidential.

4. It is also important to note that in some situations, it is important to be aware of the use of technology in that for some clients, there is a risk in using certain media such as the internet, mobile phones and cordless phones. If you use these to communicate with Leesa Poffenroth, then she will assume that it is appropriate to continue to do so in your interactions together.

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Termination
Services under the terms and aforementioned agreements will continue for the duration of the professional relationship with Leesa Poffenroth and the Named client for as long as the professional relationship exists.