Informed Consent Form

Introduction to Acupuncture, Coaching, Hypnotherapy and Meditation

Making an informed decision about whether to engage in Acupuncture, Coaching, Hypnotherapy and Meditation is an important part of the therapeutic contract. This Informed Consent Form along with the Privacy Policy informs you of what to expect from working together.

About Acupuncture, Coaching, Hypnotherapy and Meditation

Acupuncture, Coaching, Hypnotherapy and Meditation focuses mainly on helping you achieve specific measurable health and personal goals that will enhance your day-to-day life. It helps you to improve your health, to develop your potential to better manage your thoughts, feelings and behaviour. Working together within a therapeutic relationship, clients improve physical health and develop a healthier sense of self.

My obligation to you:

From my training and experience, I create a safe space where I will listen to you, and I will help you to address health concerns or break a problem down into a set of specific goals that can be measured and achieved.  I will use my training and experience to devise a therapy plan to help you achieve those goals by giving you the tools and therapy you need to change the way you think, feel and respond to challenging situations.

This is a collaborative therapeutic relationship. We will have regular feedback, discuss and agree on the steps forward.

My commitment to you in terms of confidentiality and privacy is covered comprehensively within the Privacy Policy. I comply with EU General Data Protection Regulations (GDPR) in terms of the sharing and storing of your personal information.

I will endeavour to give you as much advance notice as possible of holidays or of any need to re-schedule a future appointment. 


Your obligation to me:

Please let me know if you have any concerns about our work together. Please give me a minimum of 24 hours notice if you need to cancel your appointment. If you do not attend or are late for our session, you will still be charged for the session.

Confidentiality in Acupuncture, Coaching, Hypnotherapy and Meditation

I will keep all your information confidential and private subject to the laws of the state.  However if you disclose information that is deemed to put a child or children at risk, I am duty bound to report it as laid down in the Children First Act 2015.

I will keep your own personal records safe and secure for seven years after which time they will be destroyed safely and securely- safeguarding your anonymity at all times.

I will not acknowledge our work together to anyone without your written permission.

Fees, Session Time Frame & Frequency

The cost of sessions will vary depending on what we agree on during the assessment. I have already given you a guideline indication of the costs and time scale involved.

Your Agreement

When you book a session with me, you will be asked to fill out a form and to acknowledge that you’ve read my Informed Consent Statement and my Privacy Policy.

I’m looking forward to working with you.

Kind regards

Mary Lally