NLP Client Agreement

Welcome!

This page is a Sample Agreement form. It is not active and there is no need to fill it out until after we've had a chance to speak and discuss your goals or issues and have agreed to work together.

It's important to understand that this agreement is NOT a contract for services – e.g., it does not obligate you to use my services and it does not obligate me to provide them. It simply specifies our agreement about the terms of any services I provide.

After we have discussed your goals or issues and agreed to work together, I will send you the URL of the active version of this page from which you will be able to send your information directly to me.

If you would like a copy of our agreement for yourself, you will be able to check the "Please send a copy of this agreement to me" button on the form, and I will forward you a text copy in email manually (this protects your privacy).

If you have any questions about this agreement, please feel welcome to discuss them with me before sending this form.

IMPORTANT: This form contains functionality designed and tested for Microsoft Internet Explorer (MSIE). Other browsers may or may not work with this page. If the page's layout looks funny, or if you cannot send the form when you click the "Send Agreement" button, please come back to this page with an MSIE browser. Thanks!
Your information
*Required Fields    
*First Name:
*Last Name:
*Street Address or P.O. Box:
*City, State, Zip:
*Country:
*Daytime Phone:
Evening Phone:
Cell Phone:
*Email Address:
   
Emergency Contact Info:
Name, Relation & Phone

 
Do you wear contact lenses?
 
Yes  
No
   
 
Are you naturally left-handed or right-handed?
 
Left  
Right

Agreement

I, the client above, agree to the following terms. John David Hoag agrees to hold my name, address, phone number, email address, emergency contact info, and all personally identifiable content of our sessions as confidential to the full extent permissible by law.

*
I am over 21 years of age.
     
*

I give John David Hoag permission to guide me in my own explorations, discoveries and personal changes with NLP.
     
 

I agree to the following business arrangements:
*

—  A fee of [...please call...] U.S. dollars per hour for services rendered

*

—  To be paid either in advance or on the day services are provided... or...

 

—  Special Arrangements (See "Additional Comments" below)

   

 
  I agree to the following scheduling arrangements:
*

— I will re-schedule any appointments 24 hours in advance or pay for the missed session in full.
     
*
I UNDERSTAND AND AGREE THAT: As a Certified NLP Master Practitioner, Certified NLP Trainer and Consultant, Certified NLP Coach, Certified NLP Health Practitioner and Certified Hypnotherapist, John David Hoag's consultations are intended to be "complementary and alternative health care" as defined in California law SB 577, that John David Hoag is not a California licensed psychotherapist or physician and he does not provide psychotherapy or any other physical or mental health service which would require a California state license, nor does he hold himself out to provide such services. I agree that this agreement and all services provided by John David Hoag shall be governed by the laws of the State of California. I agree that John David Hoag's liability is limited to fees paid for our final session within a maximum period of 30 days.
  
   

 
 

Please send a copy of this agreement to me
     
    Additional comments:
   

Sending this form

Please take a moment to review your information and choices. When you are ready to send this information, click the "Send Agreement" button below [Not included on this sample page]:

 

 

"NLP was a very powerful experience."

– John Bradshaw

"NLP is one of the most brilliant psychological innovations of the 20th Century, possibly of all time."

– Rob Mason

"NLP provides a way to look past the behavioral content of what people do to the more invisible forces behind those behaviors; to the structures of thought that allow people to perform effectively."

– Robert Dilts, "Modeling With NLP"

"NLP is an incredibly effective and enjoyable way to access more of the true potential of your brain."

– Anthony Robbins