Modern Mindful Hypnotherapy

Cancellation Policy, No Refunds and Acknowledgement of Services and Fees

Subject: Self- Improvement Program using Hypnosis and NLP, IEMT and/or Guided Imagery

When booking as session this form will be attached and must be acknowledged.
I acknowledge that I understand and agree to the following:

I understand and agree that I am to receive hypnotherapy services from Lenora Curtis subject to the following conditions:

I agree to pay you for your services, in full, at the time of booking the session. Refunds are not available, but a session may be rescheduled 2 more times if give at least a 24 hour notice.

I agree to provide at least 24 hours notice for all cancellations, or changes of scheduled appointments. I understand, that missing a scheduled appointment without prior cancellation, or canceling with less than 24 hours notice, will be charged to me at the current full rate. I understand that these sessions are by mutual agreement only and can be terminated by either party (with 24 hours notice) for any reason, and that neither party is obligated in any way to continue hypnotherapy sessions.

I understand that the program of conditioning offered by you will include an undetermined number of private sessions, depending on my individual needs. I understand and agree that the major purpose of this program is for Vocational or Avocational Self-improvement and that problems of psychogenic or functional origin are treated by psychological or medical referrals only (Business and Professional Code 2908). I also understand that there are no guarantees as to the results or progress to be made, only that you will, to the best of your ability, endeavor to accomplish the objective of my sessions.

Should there be any dispute or legal complaint between myself and you, the hypnotherapist, or any other party arising from this agreement, I agree to settle any such dispute through binding arbitration and waive all rights to any civil action.


In recognition that many people receive a substantial volume of healthcare services from complementary and alternative health care practitioners, Maryland Law allows access by Maryland residents to complementary and alternative healthcare practitioners who are not providing services that require medical training and credentials. The following disclosure is provided in compliance with Section 2053.6 of the California Business and Professions Code.

The purpose of a program of hypnotherapy is for vocational and avocational self-improvement (Business and Professions Code 2908) and as alternative or complementary treatment to healing arts services licensed by the state. A hypnotherapist is not a licensed physician or psychologist and hypnotherapy services are not licensed by the State of California. Services are non-diagnostic and do not include the practice of medicine, neither should they be considered as a substitute for licensed medical or psychological services or procedures. .

Hypnosis works with the power of the subconscious mind to change habits and behaviors. The subconscious mind is considered to be the source or root of many of our behaviors, emotions, attitudes and motivations. Hypnosis is believed to be a powerful tool for accessing the subconscious mind and creating improvements in our lives.

Services consist of a program of conditioning, including an undetermined number of private sessions, depending on the client’s individual needs. The hypnotist will to the best of his or her ability endeavor to accomplish the objectives of the client’s sessions. While hypnosis may be an effective technique for many purposes, the effectiveness may vary from individual to individual, and no specific results or progress can be promised or guaranteed.

During hypnotherapy sessions, clients remain completely aware of everything that is going on. In fact, many people experience a hyper-awareness where sensations are perceived enriched and vivid. The ability to visualize or imagine is enhanced. Deep relaxation is common. Many describe the hypnotic state as a complete and total escape from physical tension and emotional stress, while remaining completely alert.

The use of hypnosis could elicit memories of past events which may or may not be literally true. It is possible that events under hypnosis will be distorted or misconstrued. Memories or images evoked under hypnosis are not necessarily accurate and may be a construction or a composite of memories. Without corroborating information, it is not possible to determine whether a specific memory is true or false, even if it seems true to the client.

While it is the practice of Hypnotherapists to keep information confidential, information revealed in hypnotherapy is not subject to the psychotherapist-patient privilege. A court may order disclosure of information learned in therapy.

I understand that my information is confidential unless I state otherwise in writing. If I report child, elder abuse or neglect or threaten to harm myself or someone else, I understand that necessary actions will be taken, and my confidentiality agreement limited in this capacity. Furthermore, if Lenora Curtis is ordered by a court to provide information or to testify, she will do so to the extent the law requires.

I understand all the information described above

If you cannot afford my services you can apply for free hypnosis with an intern from HMI by going to