Hypnotherapy Client Intake Form Template for England and Wales

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Key Requirements PROMPT example:

Hypnotherapy Client Intake Form

I need a Hypnotherapy Client Intake Form for my new wellness clinic opening in March 2025, specifically tailored for corporate clients seeking stress management therapy, with emphasis on data protection and professional insurance requirements.

Document background

The Hypnotherapy Client Intake Form is a crucial document used in England and Wales to establish the therapeutic relationship between hypnotherapist and client. It collects essential information about the client's health status, medical history, and treatment objectives while ensuring compliance with UK GDPR and relevant healthcare regulations. This document is typically completed before the first session and serves multiple purposes: risk assessment, treatment planning, legal compliance, and establishing informed consent. It's designed to protect both parties' interests while facilitating effective treatment delivery.

Suggested Sections

1. Personal Information: Client details including name, contact information, age, occupation, and demographic data in compliance with GDPR requirements

2. Medical History: Current and past medical conditions, medications, treatments, and relevant health information as per Medical Reports Act requirements

3. Presenting Issues: Primary reasons for seeking hypnotherapy, symptoms, and desired outcomes

4. Risk Assessment: Evaluation of contraindications, mental health status, and safety considerations

5. Consent Declaration: Client's informed consent for treatment, data processing, and acknowledgment of understanding

Optional Sections

1. Previous Therapy Experience: Details of past therapeutic interventions, including outcomes and experiences

2. Lifestyle Information: Diet, exercise, sleep patterns, and other lifestyle factors relevant to treatment

3. GP Information: Details of client's general practitioner and any relevant medical referrals

4. Medication Log: Detailed list of current medications and supplements, used when client is under medical treatment

Suggested Schedules

1. Privacy Notice: Detailed GDPR-compliant information about data processing, storage, and client rights

2. Terms and Conditions: Service terms including cancellation policy, payment terms, and practitioner obligations

3. Treatment Protocol: Outline of proposed treatment approach, number of sessions, and expected outcomes

4. Emergency Procedures: Protocol for emergency situations and contact information for relevant authorities

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Alternative Medicine
Wellness Industry

Relevant Teams

Clinical Services
Legal & Compliance
Administrative Services
Quality Assurance

Relevant Roles

Hypnotherapist
Clinical Director
Practice Manager
Wellness Coordinator

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Medical Intake Form

A standardized template for collecting patient information in England and Wales, compliant with UK healthcare and data protection regulations.

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Let's create your Hypnotherapy Client Intake Form

Authors

Alex Denne

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