Hypnotherapy Case-Study Client Pack
Client information and consent
For adult (18+) volunteer case-study clients. Please read this pack carefully before your session. You are welcome to print this page or save it for your records.
Practitioner: Maria Livramento
Contact: [email protected] | Tel: 07506 603703
Training provider: Evolve Life Coaching College
Insurance provider: Holistic Insurance Services
Purpose of this pack: to help you understand the case-study arrangement before attending, and to record informed consent, relevant background information, privacy choices and session notes.
1. Information for the client
- I am currently a trainee hypnotherapist. Your sessions form part of my supervised and assessed training and case-study requirements. I will not represent myself as a fully qualified hypnotherapist until I have completed the relevant qualification.
- Hypnotherapy uses hypnosis as part of a therapeutic process. Experiences vary between people and no particular outcome can be guaranteed. You remain able to communicate, ask questions and request that an exercise or session stops.
- Participation is voluntary. You may decline a technique, ask for a pause, or end a session. If you decide not to continue with future sessions, please tell me.
- Hypnotherapy is not a substitute for emergency, medical or psychiatric care. I will work only within my current training and competence. Where an issue appears outside my scope, I may recommend that you seek an appropriately qualified professional.
- For this trainee case-study service, clients must be aged 18 or over unless a separate arrangement has been specifically approved by the training provider, insurer and all applicable safeguarding and consent requirements.
2. Confidentiality and its limits
Information discussed in sessions will normally be treated as confidential and handled only for the purposes explained in this pack. However, confidentiality cannot be promised without exception. Information may need to be shared where required by law, where necessary to respond to a serious and immediate risk of harm, or where safeguarding concerns require consultation or referral. Where it is safe and appropriate, I would aim to discuss this with you first.
Because this is training case-study work, relevant case material may be discussed with or submitted to my tutor, supervisor or training provider for assessment and supervision. Wherever the course permits, identifying details will be removed or replaced with a pseudonym or initial.
3. Privacy notice — how your information will be used
I may collect your contact details, relevant background information, goals, session notes, feedback and information concerning physical or psychological health where it is relevant to the work. Health information is special category data under UK data-protection law and receives additional protection.
Purposes: arranging and delivering case-study sessions; assessing suitability and safety; maintaining appropriate records; communicating about appointments; supervision and training assessment; and meeting insurance or legal requirements where applicable.
Storage and retention: Records will be kept securely, access will be limited, and no more information will be collected than is reasonably needed. Client and case-study records are retained for a minimum of five years in accordance with professional insurance requirements. Records may be kept for longer where there is a lawful, professional, insurance-related, or other justified reason to do so.
Sharing: Information will not ordinarily be shared outside the purposes described above. It may be shared with the training provider, tutor or supervisor for assessment or supervision, with the insurer or legal advisers where necessary in connection with a claim, or with appropriate services where lawful and necessary for safeguarding or serious-risk reasons.
Your data-protection rights may include rights to be informed, access your information, correct inaccurate information, request erasure or restriction where applicable (note: this right is not absolute and may be limited by lawful retention obligations), and complain to the Information Commissioner's Office. Contact me first using the details at the top of this pack. You can also read the full Privacy Notice on this website.
4. Client intake and suitability information
This section will be completed with you before or at your first session.
Full name
Preferred name
Date of birth
Pronouns (optional)
Phone
Emergency contact name
Emergency contact number
Relationship to emergency contact
What would you like support with, and what would you like to change?
How long has this been affecting you?
What would a useful outcome from these sessions look like?
Are you currently receiving medical, psychological, counselling or psychiatric support? If yes, please give only details relevant to this work.
Are you taking any medication that you believe may be relevant to the sessions? If yes, please state.
Is there anything about your physical or mental wellbeing that you think I should know to conduct the session safely?
Have you previously experienced hypnosis or hypnotherapy? If yes, briefly describe.
Is there anything that could make lying back, closing your eyes, relaxation, imagery or focused-attention exercises uncomfortable for you?
Any accessibility, communication, cultural or practical adjustments you would like me to consider?
5. Safety and emergency information
If you disclose information suggesting a serious or immediate risk to yourself or another person, or a safeguarding concern, the session may need to move away from hypnotherapy so that safety can be considered. I may consult my training provider and, where lawful and necessary, contact appropriate emergency, health or safeguarding services. Hypnotherapy is not emergency service.
Relevant GP or health professional (optional unless required by the course or insurer)
Any agreed safety information or actions
6. Case-study and training consent
Client name
Client signature
Date
Practitioner signature
Date
7. Optional separate consent choices
These choices should not be bundled into the basic agreement where they are genuinely optional. Tick only if applicable.
8. Pre-session confirmation
Practitioner use
9. Session record template
Confidential — practitioner use
Client code or initial
Session number, date and time
Venue
Presenting focus and agreed goal
Relevant update since previous session
Techniques and interventions used and rationale
Client response and observations (objective and relevant)
Risk and safeguarding issues and action taken (if any)
Outcome and client feedback
Plan for next session and homework if applicable
Supervision questions and learning points
10. End-of-case feedback
What changes, if any, have you noticed since beginning the sessions?
What did you find most useful?
Was there anything you found unhelpful or uncomfortable?
How would you describe your experience of the sessions overall?
Is there anything you would like the trainee to know for their professional development?
Practitioner notes before using this template
This is a practical template, not a substitute for your training provider's forms, insurer's conditions or individual legal advice. Check whether your course requires particular contraindication screening, supervision, wording, retention periods, emergency procedures or tutor approval. Also check whether you need to pay the ICO data-protection fee using the ICO's official self-assessment, rather than assuming an exemption.