Contact Information: My name is Patricia E. MacIsaac. I can be contacted through my office at South Shore Hypnosis Center, 183 Whiting Street, Suite #5, Hingham, MA 02043-3845, or by telephone at 781-749-9050.

Education and Training: I was trained in hypnosis at both NGH approved training courses and at other sponsored training courses and seminars. I am a Certified Member of the National Guild of Hypnotists and I do annual continuing education to maintain my training at a high level.

Notice: "THE STATE OF MASSACHUSETTS HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Under Massachusetts law a hypnotherapist may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis or any other type of treatment from a different practitioner, the client may seek such services at any time. In the event my services are terminated by a client, the client has a right to coordinated transfer of services to another practitioner. A client has a right to refuse hypnosis services at any time. A client has a right to be free of physical, verbal or sexual abuse. A client has a right to know the expected duration of treatment, and may assert any right without retaliation."

Redress: I am a certified member of the National Guild of Hypnotists, and practice in accordance with its Code of Ethics and Standards. If you have a complaint about my services or behavior that I cannot resolve for you personally, you may contact the National Guild of Hypnotists at PO Box 308, Merrimack, NH 03054-0308, (603) 429-9438, to seek redress. Other services than my own may be available to you in the community. You may locate such providers in the telephone book.

Fees: The charge for my services is $150 per session. You will be given 30 days notice of any change in fees.

Confidentiality: I will not release any information to anyone without a written authorization from you, except as provided for by law. You have a right to be allowed access to my written record about you.

Insurance: I suggest you think of my services as something that you will pay for personally. That will both protect your privacy and help you value the work you are doing more. In general, insurance companies do not like to cover hypnotic services, and I caution you not to expect them to do so.

My Approach: I will always work for the highest and best for my clients, for your success is my success. On occasion, I might determine that hypnosis would not be in your best interest at this time, and either defer from taking you as a client, or refer you to another type of practitioner.

Client Signature: I have received and read this Client Bill of Rights and understand what I have read.

Client Name (print): ______________________________

Client Signature: _________________________________

Date: __________________________________________