A Clear Insight - Hypnosis

Gary Kaminski

36060 SW Bald Peak Road   Hillsboro  Oregon   97123

503-799-8705    gary@aclearinsight.com      http://aclearinsight.com

EDUCATION AND TRAINING:

I completed training in hypnotism and hypnotherapy at the Knightsbridge Institute located at 3446 SW Alice Street, Portland, OR, 97219, phone (503) 246-7300, which was founded by Geoffrey Knight in 1999 and is approved by the Oregon Hypnotherapy Association and certified by the National Guild of Hypnotists (NGH).

I completed Dolores Cannon’s Quantum Healing Hypnosis Technique, Level 1 on 2/27/2011, level 2 on 7/7/2011.

NOTICE:

THE STATE OF OREGON HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY.

Under Oregon 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.

THE SERVICES I RENDER ARE HELD OUT TO THE PUBLIC AS A FORM OF MOTIVATIONAL COACHING COMBINED WITH INSTRUCTION IN SELF-HYPNOSIS. I DO NOT REPRESENT MY SERVICES AS ANY FORM OF HEALTH CARE OR PSYCHOTHERAPY, AND DESPITE RESEARCH TO THE CONTRARY, BY LAW, I MAKE NO HEALTH BENEFIT CLAIMS FOR MY SERVICES.

A client has the right to refuse hypnosis services at any time

A client has the 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.

Office Location

Sage Center
10700 SW Bvrtn Hillsdale Highway, Park West Plaza, Building #3, Ste #560,
Beaverton OR 97005

REDRESS

Other services than my own may be available to you in your community. You may locate such providers on the internet or in the telephone book.

SERVICES & PRICES

I offer a free ½ hour consultation.  The following prices are for sessions at Sage Center in Beaverton :

Regular Pricing
First session 1.5 hrs $120
Second + sessions 1.0 hrs $100
Three session pkg 3.5 hrs $250
save $70
Abbreviated Past Life 2.5 hrs $160
save $60
QHHT Session 4.0 hrs $250
save $120

Please notify me of cancellation at least 24 hours prior to appointment to avoid $50 cancellation fee.

CONFIDENTIALITY:

I will not release information about you to anyone without 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. Doing so will both protect your privacy and help you place higher value on the work you are doing. In general, the insurance companies do not like to cover hypnotic services.  Do not expect them to do so.

MY APPROACH:

The most important focus in my practice is the client’s best interest. I assist clients to achieve their self-help and self-improvement goals using relaxation, guided imagery, and hypnosis. Services you are receiving are not substitutes for normal medical care. You are advised to discuss services with any doctor or mental health care professional who is taking care of you now or in the future.

CLIENT’S UNDERSTANDING:

I understand that the level of success using Hypnosis depends on different variables, including my attendance of scheduled sessions, my continuing practice, my attitude, motivation and cooperation.  I understand that personal results will vary, and that human behavior cannot be ethically warranted.

Client Name (print):

Client Signature:                                                                                                                                              Date: