New Client Pack

Good to have
you here.

Thank you for getting in touch. I'm looking forward to working with you.

The form below covers the practical and clinical information I need before we begin. It helps me make sure our work together is as precise and effective as possible from the outset. Please complete it as fully as you can before our first session.

Please find a quiet space where you won't be interrupted for sessions. If we're working online — which most clients do — a good connection and headphones make a real difference. I'll send a session link closer to the time.

Payment is due before each session. I'll confirm the method when we schedule — typically bank transfer or an invoiced payment link depending on your location.

Chris

Confidential

Client Information

Please complete as fully as possible. All information is held in strict confidence.

Clinical & Medical

Do you give permission to contact your doctor if this becomes clinically necessary?
Are you currently under the care of a medical or psychiatric professional?
Do you agree to attend sessions free from the effects of alcohol and non-prescribed substances?
Have you ever been diagnosed with epilepsy?
Have you ever received a diagnosis from a psychiatric or mental health professional?

Your Situation

What brings you here?

There is no wrong answer to any of this. I am simply building an accurate picture before we meet.

Terms & Conditions

Client Agreement

This agreement sets out the terms and conditions of our work together. Please read each clause carefully.

1Agreement to work on the issues presented by the client in no way guarantees a specific outcome or cure.
2Fees are payable in full before each session, in USD, at the agreed rate. Payment must be confirmed prior to the session commencing. Packages are valid for 12 months from date of purchase, non-refundable but transferable with consent.
3Cancellation and rescheduling: a minimum of 24 hours' notice is required to reschedule a session without charge. Less than 24 hours' notice, or failure to attend, will be charged at the full session rate.
4Between-session contact is available by email and, where included in the client's package, by WhatsApp. Contact outside agreed support hours or package inclusions is not guaranteed a same-day response.
5Behaviour deemed disrespectful or antisocial, in person or online, will result in the immediate termination of the session and the engagement as a whole.
6Confidentiality is maintained in all but the most exceptional circumstances: specifically, where a court order demands disclosure, or where there is reasonable cause to believe that not disclosing would result in serious harm to the client or others. Sharing of anonymised case material with supervisors and peer-support groups is standard professional practice and does not constitute a breach of confidentiality.
7Session notes are kept securely in line with professional guidelines for a minimum of 8 years. They are available for the client to view on request, but may not be removed or copied without consent.
8As a certified member of the National Council for Hypnotherapy (NCH), Chris Murray is bound by their code of ethics and conduct. The NCH complaints procedure is accessible at www.hypnotherapists.org.uk.
9The work undertaken is governed by the laws of England and Wales, regardless of the client's location or the medium through which sessions are delivered.
10Your agreement below indicates consent to being contacted by email for session-related correspondence, and optionally for information about future programmes or publications. You may opt out at any time.
11Sessions may not be recorded, by audio or visual means, without prior written permission from Chris Murray.
12Chris Murray reserves the right to terminate a session without warning if it becomes apparent it has been booked for a purpose other than to receive hypnotherapy. Any session fee paid in advance in such circumstances is non-refundable.

GDPR & Data

Privacy Notice

Your privacy is taken seriously. Personal information is used only to administer your engagement and provide the services you have agreed to.

Your Data Controller is Chris Murray. Information held includes your name, contact details, location, the package or programme you have engaged, and the dates of your sessions. Session notes are also held securely.

All data is held confidentially except under exceptional circumstances (a court order, or a genuine concern for safety). It is kept for a minimum of 8 years in line with professional guidelines. You have the right to request access to your data, or its removal, at any time.

Your information may be used for the following purposes:

  • ·Duty of care — to contact your GP or next of kin where clinically necessary and where you have given permission.
  • ·Accurate record-keeping for HMRC purposes, including invoicing.
  • ·Continuity of care — to refer back to previous work should you return as a future client.
  • ·Verification of practice hours with accrediting bodies (NCH and QCHPA). This may involve sharing your name, email and session dates with those bodies.
  • ·To send relevant information about future programmes or events — only with your explicit permission. You may opt out at any time.

NLP Assessment

Representational System
Preference Test

For each statement, rank every option using the scale below. Use each number once only per question.

4 = most like you 3 = next most like you 2 = next to least like you 1 = least like you
1. I make important decisions based on:
Gut level feelings
Which way sounds best
What looks best to me
Precise review and study of the issues
2. During an argument, I am most likely to be influenced by:
The other person's tone of voice
Whether or not I can see the other person's argument
The logic of the other person's argument
How I feel about that person's argument
3. I mostly communicate what is going on with me by:
The look I give
The feelings I share
The words I choose
The tone of my voice
4. It is easiest for me to:
Find the ideal volume and tuning on a stereo system
Select the most intellectually relevant point in an interesting discussion
Select the most comfortable furniture
Select attractive colour combinations
5. I am:
Very sensitive to the sounds of my surroundings
Very adept at making sense of new facts and data
Very sensitive to the way clothing feels on my body
Very likely to have a strong response to colours and the way a room looks

Clinical Baseline

Outcome Measures

These are standard clinical measures. Your answers give us a baseline to track progress over the course of our work together.

Over the last two weeks, how often have you been affected by the following?

Not at all
0		 Several days
1		 More than half
the days
2		 Nearly every
day
3
Anxiety
Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen
Mood
Little interest or pleasure in doing things
Feeling down, depressed or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself, or that you are a failure
Trouble concentrating on things
Moving or speaking more slowly, or more restlessly, than usual
Thoughts that you would be better off dead or of hurting yourself

Over the last two weeks, how often have the following been true for you?

None of
the time
1		 Rarely
2		 Some of
the time
3		 Often
4		 All of
the time
5
Wellbeing
I've been feeling optimistic about the future
I've been feeling useful
I've been feeling relaxed
I've been dealing with problems well
I've been thinking clearly
I've been feeling close to other people
I've been able to make up my own mind about things

By submitting this form you confirm that all information provided is accurate and complete to the best of your knowledge, and that you have read and agreed to the Client Agreement and Privacy Notice above.

All information is treated with strict confidentiality.