Client Bill of Rights

CONTACT INFORMATION:Steve Roehm, PO Box 95, Mt Juliet, TN, 37121. (615) 430-4735, [email protected], or www.NashvilleHypnosis.com.

AGREEMENT: The following agreement is between ROEHM, LLC, DBA Nashville Hypnosis, (here forth known as “I/me/my/mine/our/we/us”), and you (here forth known as “client/you/your”)

EDUCATION & TRAINING:All education and training is posted and regularly updated at www.NashvilleHypnosis.com

NOTICE: “THE STATE OF TENNESSEE HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR THE PRACTICE OF HYPNOTISM. THISSTATEMENT OF CREDENTIALS IS FOR INFORMATIONAL PURPOSES ONLY. Under Tennessee law, a hypnotist 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. 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.”

FEES:Please call for current pricing. Payment is due in full at time of booking. We accept cash, PayPal, Venmo, and all major credit cards. Fees are subject to change at any time without notice. Also, see Cancellation Policy and Guarantee Policy. Checks are not accepted.

CURRENT PRICING: Call for current prices 615-430-4735

SESSION VENUE: All sessions will be delivered via Zoom video conferencing(Zoom.us)app unless otherwise agreed upon (see next section). The client is responsible for downloading the app, setting it up and ensuring all equipment is working properly. Zoom is free to you.

TRAVEL: Some clients prefer to have face-to-face sessions and we are happy to accommodate. Local travel rates are $350/hour with a minimum charge of one hour each way in addition to session fee. Distance travel rates are $25000/day plus expenses, business class airfare, mid-size+ car rental and minimum four-star accommodations. The client is responsible for arranging a quiet, non-smoking location. All fees are to be paid in advance. Travel arrangements will be made by Nashville Hypnosis and compensated by client.

AFTER HOURS/WEEKEND: After hours and weekend sessions may be possible at 2x current rate and only at a mutually agreed upon time. See pricing. Client session hours are Tuesday, Wednesday and Thursday 10 AM - 6 PM CST.

PREPAYMENT: Full payment is required to schedule your initial session. We still require a minimum 48 hours cancellation notice, or you are financially responsible for your time scheduled. The payment is non-refundable unless the proper 48+ hour cancellation notice is given.

CANCELLATION POLICY: Your appointment time is reserved exclusively for you. Please login promptly to obtain your full session. We require a minimum 48-hourscancellation notice. Unless canceled with 48, or more, hours notice, you are financially responsible for the time reserved. If you must cancel, or reschedule, an appointment due to an emergency, please notify us as soon as possible. Thank you for your consideration. If you must cancel with less than 48 hours notice, full payment for your next session is required before we will schedule a new session, regardless of reason. If you choose not to reschedule a future appointment, your credit card will be billed for the balance of the session missed/canceled.

ACCEPTANCE OF TERMS AND CONDITIONS: By providing your digital signature on the registration page, paying your deposit or submitting your intake forms, you accept all terms and conditions as written here.

TARDINESS POLICY: Tardiness of more than 15 minutes will result in cancellation of your appointment unless otherwise agreed upon. This time has been set aside especially for you and we want you to get the full benefit. (See Cancellation policy above.)

NO CALL/NO SHOW: In the event of a no call/no show situation, in addition to Cancellation/Tardiness Policies, the client will be billed for full session cost. No refunds will be given for no call/no show clients.

SPECIAL CIRCUMSTANCES: In the event of an automobile accident, illness or act of God, the client may be released from certain obligations at our discretion. Proof of circumstances may be required. With less than 48-hours notice, the client's session will be rescheduled at our mutual convenience. No monetary refunds will be given with less than 48-hours notice.

BILLING: We do not provide billing or payment plans. All sessions are to be paid for at the time of booking.

PREPAID SESSIONS: The same cancellation policy applies to prepaid visits. Failure to keep your appointment or short-notice cancellation will result in the forfeiture of a prepaid visit. No refunds will be given for unused prepaid sessions after 90 days from payment. Package prices will be honored for one year from payment. After one year, the balance may apply to current pricing.

CONFIDENTIALITY: Anything you tell us is held in strict confidence. We will not release any information to anyone without written authorization from you, except as provided for by law.

MINORS: Appointments or classes for children under age 18 require written permission from parent or guardian.

ENVIRONMENT: You are responsible for your environment. If your phone rings, in the middle of the session, your session may be considered complete. Noisy and chaotic environments are not conducive to hypnosis and you are responsible for your immediate environment during our session time. Please assure all pets are secure and away from your session environment. Failure to secure a quiet space may void your session at full price.

TECHNOLOGY: You are responsible for your technology, ie: internet, webcam, headphones and any other items needed to connect during our session time. Failure to check your equipment prior to our session may void your session at full price at our discretion.

ARCHIVING: We reserve the right to video, and/or audio, record any session, in full or in part, for archival, liability and/or educational purposes. No recording will be released for public display unless otherwise mutually agreed upon. Your privacy is of utmost importance.

PRIVACY: Your information will never knowingly be shared, sold or distributed in any form. We respect your privacy. The integrity of your private information is absolute, barring any breach of our security systems, except as provided for by law.

INSURANCE: We do not file insurance or any other third party claims. Insurance companies usually consider hypnosis as an alternative therapy and therefore do not cover it. Upon request, we will provide a statement for Flexible Spending Plans or Employer Programs. we do accept FSA and HSA payments through their respective debit cards.

GENERAL PROVISIONS: If any portion of this Agreement is found invalid or unenforceable, that portion shall be severed and the remainder of this agreement shall remain in force. This agreement constitutes the entire agreement between us pertaining to its subject matter and supersedes all of our prior agreements, representations, and understandings. Subject to General Provisions, no supplement, modification, or amendment of this agreement shall be binding unless executed in writing by both parties. No waiver of any of the provisions of this agreement shall be deemed, or shall constitute, a waiver of any other provision, whether or not similar, nor shall any waiver constitute a continuing waiver. No waiver shall be binding unless executed in writing by the party making the waiver. This agreement may be executed in one or more counterparts. Each shall be deemed an original, but all of which together shall constitute one and the same instrument. In the event of a dispute, the parties agree to submit the matter to the Community Dispute Resolution Service or any recognized Arbitration Board located, wholly at clients expense, within our state and county, before instituting litigation.

NOTICES: All notices, requests, demands, and other communications under this agreement shall be in writing and shall be deemed to have been given on the date of delivery: if delivered personally to the party to whom notice is to be given; if sent by electronic mail with a cc: to sender; if sent by fax; or on the third day after mailing by first class mail.

CHANGE OF TERMS OF SERVICE: We reserve the right to change the terms and conditions of this agreement as needed. Use, and/or scheduling, of our services by you, after said changes, constitutes acceptance of those new terms and conditions.

OUR APPROACH:We believe that individuals have the right to choose, or practice, alternative or complementary self-improvement services. Hypnosis is safe and non-invasive. It is a wonderful tool that you can use to help yourself. The services we render are held out to the public as a form of motivational coaching and education, combined with instruction in self-hypnosis. We do not represent our services as any form of healthcare, psychotherapy or counseling and despite research to the contrary, by law, we may make no health benefit claims for our services. Hypnosis is not meant to be a substitute for psychological or professional counseling. If you have an ongoing mental health problem, please consult a professional licensed by your state. We use hypnosis to motivate clients to eliminate negative or unwanted habits, facilitate the learning process, improve memory and concentration, develop self-confidence, eliminate fears, improve athletic ability, reduce stress and for other social, educational and cultural endeavors of a non-medical nature. In general, we help people cope with the normal problems of everyday living by utilizing various techniques of hypnosis. Hypnosis reduces stress, which is a beneficial adjunct for many medical or mental health disorders. Hypnosis can be used to reduce pain, discomfort and improve certain health problems. For anything related to pain relief or other medical or mental issues, we require a written referral from your applicable licensed medical, dental or mental health professional. All other issues may be self-referrals.

BILLING: We do not provide billing or paymIn Health-related matters – We DO NOT DIAGNOSE, TREAT, OR PRESCRIBE. We offer Hypnosis information and services to help you cooperate with your doctor or physician in your mutual plan of building better health. In the event that you use this information without your doctor’s approval, you are prescribing for yourself, which is your constitutional right and you do so at your own risk and liability.

TERMINATION OF SERVICES: We reserve the right to refuse, and/or terminate, service to anyone, for any reason, at any time.

REFUNDS FOR UNUSED SESSIONS: No refunds will be given for unused sessions after 30 days from the last visit. Refunds are not given for services rendered, see next section. If you purchase a package and decide to cancel your unused sessions, refunds will be given based on used sessions at full price, i.e., (Note: This is only an example and may not reflect current prices) if you purchase a 4 session package at $1300, use three sessions and decide to cancel your last session, you will receive a refund based on current full session price for used sessions ($1300(package price)-$450(or current initial session price)-$600($300/ea for two used follow-up sessions)=$150 refund). Discount packages will also be refunded on the above formula considering all used sessions at full price. No refunds after 90 days from payment date.

Refunds of canceled sessions for any discounted package will be based on sessions served at full price, not at the discounted price offered.

GUARANTEES:No guarantees as to the efficacy of hypnosis for your particular problem are made or implied, as it is impossible to guarantee human behavior or compliance. Hypnosis is a tool you use to help yourself; therefore no refunds for services rendered are given. We are not responsible for actions, behaviors or choices any client makes before, during or after any session. You are an autonomous adult and possess full free will to make choices and take action. We do pledge our efforts to help you to the best of our abilities and we sincerely want you to succeed!

By registering as a client of Nashville Hypnosis, you are agreeing to the above terms of service as agreeable and binding and this agreement constitutes a contract between you and Nashville Hypnosis.

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