Consent for Telepsychology and Online Hypnotherapy

    Your typed name below, will act as your signature and acceptance of this form.

    Consent to Telepsychology and Online Hypnotherapy:

    I understand that my online counseling and hypnotherapy sessions with Dr. Eimer will be conducted using virtual meeting software such as Zoom. My signature below attests to the fact that I accept the terms and conditions stipulated in the Client/Patient Services Agreement & Informed Consent for Telepsychology, Counseling, Hypnotherapy & Office Sessions. I give Dr. Eimer my informed consent to:

    (a) provide counseling, psychotherapy, clinical hypnosis, and hypnotherapy to me.

    (b) release my clinical and administrative records to my insurance company for billing.

    I have read and understand the terms as stated on the Client/Patient Services Agreement & Informed Consent for Telepsychology, Counseling, Hypnotherapy & Office Sessions. Click here to read Informed Consent for Telepsycholology.