top of page

Parental Consent Form

Parental Consent Form

Dear Parent / Guardian / Carer,


In order to comply with the conditions of my Insurance company can you please give permission for your child to have Solution focused Hypnotherapy sessions without your presence in the therapy room.


I can confirm that I am DBS enhanced checked.

I give permission for Caron Iley at Havisham Hypnotherapy to treat my child without my presence in the therapy room
No
Yes

Awards & Accreditations

Get In Touch by Calling 07580 041394

Havisham-Hypno-Logo-300-×-300px_edited.p

Havisham Hypnotherapy
Dodd Lane Business Park
Unit R
Chorley Road
Westhoughton
BL5 3NA

bottom of page