Before we begin, please read this agreement and then sign and date it. This will let us know that you have read and that you understand what is written here. This form will ask you about your present condition for which you seek therapy as well as any other issues you might have. It also sets out the context in which you will get the outcome you want. It also covers some of the issues of law governing our relationship.
1. Time Line Therapy®
Time Line Therapy® is a complimentary health care, the person you are working with is not a Medical Doctor, psychiatrist or psychologist. Nothing that happens here in therapy should be construed as, nor should you believe that it is a substitute for the advice of a licensed medical professional perso.
2. What to Expect
Your practitioner has been trained and certified Time Line Therapy® at the Master Practitioner level and will be doing this technique along with Neuro-Linguistic Programming (NLP) and Hypnosis. The therapy will probably be different from what you might have expected. In total, we will not spend a lot of time talking about the problem, just gathering information about it. In fact, most of the session(s) are about other things.
It is very important for us to discover the internal thought process of HOW you create the problem. That means that we are looking for your strategy, or how you structure the problem. Because our focus is on structure, that means that, once we discover it, we can move on and focus on having the problem disappear very quickly.
Because of this, your Time Line Therapy® Master Practitioner may cut short your answers or even talk about your problem in ways that you never considered. He may even ask you questions that you do not totally understand consciously in order for your Unconscious Mind to make changes you want at the unconscious level. It is important to do this so that we can reduce the time taken for the therapeutic process.
If you have been in a therapy session before, expect that this one will be very different.
3. This is the Process
We begin with you telling us the problem. We will ask you for examples of the problem and other questions to discover HOW you do it in your head. We will also probe to discover the source of the problem – the precipitating event(s). Some time before the end of this part of the session we will ask you what has to happen so you will know the problem is gone
4. After the session
We will probably assign you some very specific tasks to do. If assigned these tasks are, absolutely, a fundamental part of the therapy. They may take up to several days or weeks to complete. The tasks are directly related to the circumstances that created the problem. YOU MUST DO THEM. If you do not, then neither you nor we can predict the outcome of the therapy.
The second thing that is important is that you will need to stubbornly focus on what you want. The people who are the happiest overall in life are those who recognise that you have a choice to focus on what you don’t want or what you do want. You can focus on negative emotions and things that make you feel bad, or you can focus on positive emotions and things that make you feel good. It is your choice. After the session, YOU MUST FOCUS ON WHAT YOU WANT.
Finally, if your old pattern rears its ugly head, then you must refuse to run that pattern again. Please remember that we have the utmost total and complete respect for you and absolutely no respect for your old problem.
5. This is Complimentary Health Care Therapy
Your Time Line Therapy® Master Practitioner is a Complementary Healthcare Provider, and not a Medical Doctor, Psychologist or Psychiatrist. The services you receive are not regulated by a government body. The self-regulated holistic treatments and client-centred disciplines in which your practitioner is trained and in which he has experience include, consulting and coaching, Time Line Therapy® techniques, Neuro-Linguistic Programming (NLP) and Hypnosis. We will always provide only those services in which we have been trained, and if we find that we cannot help you, we will refer you to a licensed person who can assist you. During your therapy session we will use one or more of the following techniques:
a. Time Line Therapy® techniques: The techniques are a process of active imagination where the client imagines floating above his Time Line and letting go of his negative emotions and or limiting decisions (or limiting beliefs). Then the client is also asked to imagine creating events in his future that support his goals or outcomes. Time Line Therapy® techniques have demonstrated results in a broad variety of presenting problems. It is a powerful technique which allows clients to make long-lasting changes in a very rapid way. Your practitioner is certified as a Time Line Therapy® Master Practitioner by the Time Line Therapy® Association.
b. Neuro-Linguistic Programming (NLP): NLP is a model of communication, how we communicate to self and others and how that communication creates and affects our behaviour. As a study, it is synthesis of cognitive and behavioural philosophies which focus on the information coming in through the neurology (cognitive) and the programmes we run inside our heads to produce the behaviours (behavioural) we do. Your practitioner is certified as an NLP Master Practitioner by the American Board of Neuro-Linguistic Programming.
c. Hypnosis: This is the use of trance to make changes at the unconscious level. Hypnosis has been used to produce unconscious change with clients since 1843. All of our practitioners are trained and certified as Hypnotherapists by the American Board of Hypnotherapy. Should the Practitioner wish to use hypnosis with you may still retain conscious awareness throughout or you may not. Therefore you can ask to have a third person present or you can bring one with you. This is your choice.
6. Confidentiality& Data
We keep all information we receive from you confidential and do not disclose it to persons outside our company. All client information is kept strictly confidential and is for our internal use only. The data we keep is personal contact details, and personal information that you have shared with the Practitioner. If you shared that information electronically, it is stored electronically, other than that personal information that you share is stored in a paper form. We only keep this information to help the Practitioner to help you to achieve the positive changes that you want to make. We keep all of this information for ten years after the most recent contact that you have had with us, in case you have a desire to return at a future date.
7. Your Choice, Your Responsibilit
While, during the session, we offer you advice and other ways of looking at your problem and its solutions for your consideration, you hereby agree that whatever we discuss is only our perspective and is not binding upon you, nor is it a prescription. If you want to discuss our suggestions with someone else, you should discuss them with a health care provider. It is your responsibility to communicate your results to us. Our liability is limited to the amount paid for the therapy
For and on Behalf of Pankaj Garg ___________________________________
Client name __________________________________________________________
Client Signature _______________________________________________________