Rewire Your Mind Therapy

Client Information and Informed Consent

Myrene Dickinson, M.A. — Clinical Hypnotherapist | CBT & NLP Coach Telephone: (520) 210-5461 Form version: October 18, 2026

Please read this information carefully. You are welcome to ask questions before deciding whether to participate.

Understanding the Services

Myrene Dickinson provides personalized hypnotherapy, coaching, guided relaxation, and meditation within her training and qualifications. Approaches will be discussed with you and selected according to your goals and comfort.

Myrene Dickinson is a clinical hypnotherapist, not a licensed counselor.

These services do not include medical diagnosis, prescribing medication, or replacing care from a licensed medical or mental health professional. A master's degree and hypnotherapy certification are not the same as a license to practice psychology or psychotherapy.

Please continue prescribed care and discuss medication changes with your prescribing professional.

Your Choice and Participation

Participation is voluntary. You may decline an exercise, ask questions, request a different approach, or stop a session at any time. Hypnosis does not require you to surrender control or disclose information you wish to keep private.

Other options include declining these services or seeking support from a licensed healthcare professional.

Possible Benefits and Discomfort

Experiences and results vary. No particular outcome or number of sessions is guaranteed.

Hypnosis and related exercises may bring up uncomfortable emotions or memories. Other possible reactions include headache, dizziness, nausea, sleepiness, anxiety, or distress. Please tell Myrene promptly if you feel uncomfortable so the session can pause or stop.

Images or impressions experienced during hypnosis are not proof that a past event occurred. Memory exploration or regression will not be used to establish historical facts.

Relevant Information and Suitability

Please discuss health or mental health concerns that may affect participation privately before the session. Myrene may recommend postponing services, obtaining guidance from a treating professional, or seeking a different provider when appropriate.

Please do not enter detailed medical information in this website form.

Privacy and Communication

Personal information will be handled with care and shared with your permission, except when disclosure is required or permitted by applicable law, such as certain safety concerns, reporting obligations, or valid legal process. Absolute confidentiality cannot be promised.

Email, text messages, and online platforms involve privacy risks. Please use email and text primarily for scheduling and administrative matters. This consent does not authorize marketing, testimonials, or recording sessions. Recording requires a separate agreement.

Online Sessions

For online appointments, please participate from a private, stationary location. Do not participate while driving, operating equipment, or under the influence of substances that impair participation.

At the start of each online session, we will confirm your physical location, a callback number, and a plan for a lost connection or urgent concern. Appointment availability depends on your location and applicable requirements.

Fees and Appointment Policies

The standard session fee is $135 for up to 90 minutes, unless a different arrangement is agreed in writing before booking.

The introductory consultation is 15 minutes at no charge and does not include treatment.

Payment timing, cancellation, rescheduling, and refund terms will be provided in writing before you book a paid appointment. No additional fee or policy is created by this consent form.