Case History Form

Please fill out the following form as fully as possible so we have the clearest view of your case. The information provided on this form is confidential and will not be shared with anyone other than Chris and his team.

Terms and Conditions

This document in its signed form is a therapeutic agreement between Clinical Hypnotherapist Chris O’Hanlon MSBCH and the patient listed above.

Fees and Payment Details

The initial consultation fee is £40.00. Fees of between £50-£90 per hour (per session), upon agreement by the patient and Chris after the initial consultation, are payable by bank transfer, cash or cheque accompanied by a valid cheque guarantee, before the commencement of each session. Fees are non-refundable and non-transferable. Failure to complete treatment renders this agreement void and may reduce the overall effectiveness of the therapy.


Confidentiality is maintained in accordance with the British Society of Clinical Hypnotherapists (BSCH) guidelines. Exceptions that may require the breaking of confidentiality include; General Practitioners’ consent, patient referral, clinical supervision or the immediate risk of danger to the patient or others; Offences covered by; The Children Act 1989 (S47), The Drug Trafficking Offences Act1989 S27 (as amended by the Criminal Justice Act 1993), The Terrorism Act 2000 or serious crime. British courts may also order information disclosure.

With some conditions Chris may request permission from you to write to your doctor, letting them know you are having hypnotherapy. Only medical history relating to your presenting symptom will be discussed. Permission to record sessions may be requested. I respect your right to refuse. Information is stored and protected in accordance with the Data Protection Act. Patient information will not be passed on for marketing purposes. Chris has an obligation under his membership of the BSCH to continue his professional learning and development and therefore may share case histories with supervisors and peer-support groups. All information will be anonymous and this will not be a breach of professional confidentiality.


Appointments generally require 60 minutes. Prompt arrival and early notification of late arrival are appreciated. Time permitting, patients arriving late will receive treatment for the duration of their original appointment. If time does not permit, the duration of the session will
be reduced by the time of late arrival.

Appointment changes or cancellations can be made by calling 07971 567680 and require a minimum of 24 hours notice for cancellation, otherwise, a cancellation fee of 100% of that session payment is chargeable. Chris will use his discretion if there are unforeseen and unavoidable circumstances.

Repeated late arrival, cancellation or missing of appointments may result in treatment termination. Chris will endeavour to give you as much notice as possible of appointment changes or cancellations.

Contact Outside of the Sessions

Telephone contact is available during office hours of; 9.00 am-8.00 pm Monday to Friday. Telephone messages and emails will be replied to at Chris’s earliest convenience. In the case of emergencies contact your General Practitioner or the emergency services immediately if the health of yourself or others is at risk. *Strictly Private and Confidential*

Case History

Professional therapeutic boundaries will be observed and maintained at all times by both therapist and patient. Confidentiality will be protected outside of the therapeutic environment with recognition or acknowledgement of patients being withheld.


There may be a requirement for work to be carried out between and after sessions as part of the treatment, failure to do so may reduce the effectiveness of therapy.

Sobriety and Safety

You should seek the advice of a qualified medical practitioner before commencing any treatment or if you have any questions related to your mental or physical health, physical fitness, or medical conditions. Also, it is not recommended that you stop or alter any
treatment you are currently receiving without the prior consent of your doctor or mental health advisor. This treatment does not replace any treatments or prescribed medications currently being undertaken.

Patients arriving or appearing to be intoxicated will be refused treatment (exceptions apply).
Anti-social behaviour will result in therapy being immediately terminated and may result in your prosecution.
Copies of BSCH’s ethical framework and guidelines can be found online at

Chris reserves the right to review and re-negotiate terms and conditions, fees and charges.

During the process of treatment, there may be reason to review some unpleasant memories or to experience some uncomfortable emotions. It is acknowledged that making personal changes in behaviour, thinking and emotions through hypnotherapy sometimes requires learning by trial and error and some confusion or setbacks in the process may occur. You (the patient) acknowledge and agree to accept these potential occurrences.

Clinical Hypnotherapy

Chris is a member of the British Society of Clinical Hypnotherapists. As a clinical hypnotherapist my aim is to ensure that all of those amazing people I work with receive the very best treatment, while being able to work towards measurable goals. I’ve always been incredibly passionate about helping people and assisting them in their journey to become mentally and physically stronger. The process is about facilitating positive change, which brings greater insight and belief into one’s abilities and direction. Hypnotherapy is about working together in helping the unconscious mind find solutions. It’s an opportunity to incorporate a positive mindset and in so doing create a stronger, more confident person”.