Disclosure Statement
Longmont Hypnosis, LLC
720-491-9694
Leslie “Easton” Harrison was initially trained and certified by the National Guild of Hypnotists at the Brigham Hypnosis Center and trained as a Consulting Hypnotist in 2013. In 2014 I was certified by the American Council of Hypnotist Examiners as a Hypnotherapist. In 2018 I was Board Certified as a Hypnotist by the International Association of Counselors and Therapists (IACT). In 2019 I became a Certified Instructor for the National Guild of Hypnotists (NGH). Also, in 2014 I became registered by the State of Colorado as a Unlicensed Psychotherapist NLC.0105108. My highest degree is a Bachelor of Science Degree in Business Administration with the University of California, Sacramento and I practice as a unlicensed psychotherapist practicing hypnotherapy. I do annual continuing education to maintain my training at a high level.
The practice of licensed or unlicensed persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Registrations. The Board of Unlicensed Psychotherapists Examiners can be reached at 1560 Broadway, Suite 1350, Denver, Colorado 80202, (303) 894-7800. As to the regulatory requirements applicable to mental health professionals: Unlicensed psychotherapist is a psychotherapist listed in the State's database and is authorized by law to practice psychotherapy in Colorado but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain a registration from the state.
In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant or certificate holder. You are entitled to receive information from your therapist about the methods of therapy, the techniques used, the duration of your therapy (if known), and the fee structure. You can seek a second opinion from another therapist or terminate therapy at any time.
The charge for psychotherapy is $135 an hour. Payment is due at the conclusion of each session. Since I have reserved our appointment time for you, it is my policy to charge $45 for cancellations received less than 24 hours notice unless we are able to reschedule the appointment within the same week. There is no charge for brief calls. Calls lasting longer than 10 minutes will be charged to the client on a prorated basis.
I am available to receive phone calls during most normal business hours. If I am in session, you will get my voice messaging. I pick up my messages regularly. If you have a major emergency and cannot reach me, you may need to seek help at a mental health center or hospital.
It is always your right to terminate therapy at any time. However, I strongly encourage you to discuss this decision with me. It has been my experience that, particularly in a therapeutic relationship of any length, termination is a very important process. If I see you approaching readiness to leave therapy, I will certainly discuss this with you. I will also discuss your progress at any time.
Fees:
General fees are $179 for an initial hypnosis screening to determine the effectiveness of hypnosis for you, followed by $135 each for 2 or 3 Foundation Sessions (usually one hour sessions). Payment is due at each session. The fees will not change during your sessions. Payment may be made in cash, credit card or personal check to Longmont Hypnosis, LLC.
Services and Programs:
Introductory Session – 75 minutes – 179.00
Book an introductory session to learn about hypnosis, experience hypnosis and explore (under hypnosis) what it is that you can do better.
Soften Stress – 50 minutes – 135.00
With hypnosis, you can soften stress and learn tools to manage stress better. A hypnotic anchor is given that can be used to find calm and choose well rather than react to stress. Hypnosis recording available upon request.
Healthy Weight Management Introductory Session – 75 minutes – 179.00
Hypnosis can help motivate to eat right and make exercise natural and fun. This introductory session is to jump start this process. Recording is available upon request. Follow-up sessions as needed.
Healthy Weight Follow-up Session(s) – 50 minutes – 135.00
After you have had an introductory session for Healthy Weight Management, you can sign up for one or more follow-up sessions as needed. These are 50 minutes each.
Smoking Cessation Program – Session 1 (3 Sessions included with price) – 75 minutes – 495.00
Hypnosis is very effective to help end dependency on tobacco and nicotine. The program includes 3 sessions. You smoke your last before the second session. Recordings are provided.
Smoking Cessation Sessions 2 and 3 – 50 minutes – 0.00 (included with Smoking Cessation Program)
After the introductory session, sign up for session 2 and session 3 during the 7 to 10 days following the introductory session. The entire fee is paid at the introductory session.
Age Regression – 105 minutes – 199.00
Sometimes we do things that we wish we didn't do, but we don't know why, and we can't stop. This can be due to us protecting ourselves in some way from something in our past. Hypnotic age regression follows feelings and emotions back in time to the first time, and then allows the mature, objective adult in us to love and rescue the younger self, promising to always be there.
Hypnosis for Children – 50 minutes – 135.00
Hypnosis can help children learn to use their minds better, engaging the subconscious to find better focus, manage stress, have a better outlook, find motivation, and overcome challenges. Hypnosis for ADD available. Recording available upon request.
Just Hypnotize Me – 50 minutes – 135.00
Hypnosis is relaxing, energizing, and fun. Choose the Just Hypnotize Me option if you would just like to experience hypnosis for whatever happens to be bubbling up for you today. Recording available upon request.
Insurance: I suggest you think of my services as something that you will pay for personally, however, check with your insurance company about their coverage. I am happy to submit a claim on your behalf if you provide me with the form. In the case of smoking cessation, ask your employer or insurance company if they will reimburse you.
My Approach: I use the very effective tool of hypnosis to assist everyday people with everyday problems like Stress and Anxiety Softening, Focusing Techniques, Smoking Cessation, Weight and Wellness issues, and other compulsive habits and self-defeating behaviors. I assist the client to access his/her subconscious mind, and to replace negative thoughts and programming with positive suggestions that motivate and inspire the changes he/she desires. I teach all clients to do Self-Hypnosis so they can reinforce those suggestions so that they will become a permanent part of their present and future.
Client Signature: I have read the preceding information, it has also been provided verbally, and I understand my rights as a client or as the client’s responsible party.
__________________________________________
Client’s name Date
__________________________________________
Client’s Signature Date
If signed by Responsible Party, please state relationship to client and authority to consent: _____________________________________
Longmont Hypnosis, LLC
720-491-9694
Leslie “Easton” Harrison was initially trained and certified by the National Guild of Hypnotists at the Brigham Hypnosis Center and trained as a Consulting Hypnotist in 2013. In 2014 I was certified by the American Council of Hypnotist Examiners as a Hypnotherapist. In 2018 I was Board Certified as a Hypnotist by the International Association of Counselors and Therapists (IACT). In 2019 I became a Certified Instructor for the National Guild of Hypnotists (NGH). Also, in 2014 I became registered by the State of Colorado as a Unlicensed Psychotherapist NLC.0105108. My highest degree is a Bachelor of Science Degree in Business Administration with the University of California, Sacramento and I practice as a unlicensed psychotherapist practicing hypnotherapy. I do annual continuing education to maintain my training at a high level.
The practice of licensed or unlicensed persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Registrations. The Board of Unlicensed Psychotherapists Examiners can be reached at 1560 Broadway, Suite 1350, Denver, Colorado 80202, (303) 894-7800. As to the regulatory requirements applicable to mental health professionals: Unlicensed psychotherapist is a psychotherapist listed in the State's database and is authorized by law to practice psychotherapy in Colorado but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain a registration from the state.
- Certified Addiction Counselor I (CAC I) must be a high school graduate, complete required training hours and 1,000 hours of supervised experience.
- Certified Addiction Counselor II (CAC II) must complete additional required training hours and 2,000 hours of supervised experience.
- Certified Addiction Counselor III (CAC III) must have a bachelor’s degree in behavioral health, complete additional required training hours and 2,000 hours of supervised experience.
- Licensed Addiction Counselor must have a clinical master’s degree and meet the CAC III requirements.
- Licensed Social Worker must hold a master’s degree in social work.
- Psychologist Candidate, a Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in the process of completing the required supervision for licensure.
- Licensed Clinical Social Worker, a Licensed Marriage and Family Therapist, and a
- Licensed Professional Counselor must hold a master’s degree in their profession and have two years of post masters supervision.
- A Licensed Psychologist must hold a doctorate degree in psychology and have one year of postdoctoral supervision.
In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant or certificate holder. You are entitled to receive information from your therapist about the methods of therapy, the techniques used, the duration of your therapy (if known), and the fee structure. You can seek a second opinion from another therapist or terminate therapy at any time.
The charge for psychotherapy is $135 an hour. Payment is due at the conclusion of each session. Since I have reserved our appointment time for you, it is my policy to charge $45 for cancellations received less than 24 hours notice unless we are able to reschedule the appointment within the same week. There is no charge for brief calls. Calls lasting longer than 10 minutes will be charged to the client on a prorated basis.
I am available to receive phone calls during most normal business hours. If I am in session, you will get my voice messaging. I pick up my messages regularly. If you have a major emergency and cannot reach me, you may need to seek help at a mental health center or hospital.
It is always your right to terminate therapy at any time. However, I strongly encourage you to discuss this decision with me. It has been my experience that, particularly in a therapeutic relationship of any length, termination is a very important process. If I see you approaching readiness to leave therapy, I will certainly discuss this with you. I will also discuss your progress at any time.
Fees:
General fees are $179 for an initial hypnosis screening to determine the effectiveness of hypnosis for you, followed by $135 each for 2 or 3 Foundation Sessions (usually one hour sessions). Payment is due at each session. The fees will not change during your sessions. Payment may be made in cash, credit card or personal check to Longmont Hypnosis, LLC.
Services and Programs:
Introductory Session – 75 minutes – 179.00
Book an introductory session to learn about hypnosis, experience hypnosis and explore (under hypnosis) what it is that you can do better.
Soften Stress – 50 minutes – 135.00
With hypnosis, you can soften stress and learn tools to manage stress better. A hypnotic anchor is given that can be used to find calm and choose well rather than react to stress. Hypnosis recording available upon request.
Healthy Weight Management Introductory Session – 75 minutes – 179.00
Hypnosis can help motivate to eat right and make exercise natural and fun. This introductory session is to jump start this process. Recording is available upon request. Follow-up sessions as needed.
Healthy Weight Follow-up Session(s) – 50 minutes – 135.00
After you have had an introductory session for Healthy Weight Management, you can sign up for one or more follow-up sessions as needed. These are 50 minutes each.
Smoking Cessation Program – Session 1 (3 Sessions included with price) – 75 minutes – 495.00
Hypnosis is very effective to help end dependency on tobacco and nicotine. The program includes 3 sessions. You smoke your last before the second session. Recordings are provided.
Smoking Cessation Sessions 2 and 3 – 50 minutes – 0.00 (included with Smoking Cessation Program)
After the introductory session, sign up for session 2 and session 3 during the 7 to 10 days following the introductory session. The entire fee is paid at the introductory session.
Age Regression – 105 minutes – 199.00
Sometimes we do things that we wish we didn't do, but we don't know why, and we can't stop. This can be due to us protecting ourselves in some way from something in our past. Hypnotic age regression follows feelings and emotions back in time to the first time, and then allows the mature, objective adult in us to love and rescue the younger self, promising to always be there.
Hypnosis for Children – 50 minutes – 135.00
Hypnosis can help children learn to use their minds better, engaging the subconscious to find better focus, manage stress, have a better outlook, find motivation, and overcome challenges. Hypnosis for ADD available. Recording available upon request.
Just Hypnotize Me – 50 minutes – 135.00
Hypnosis is relaxing, energizing, and fun. Choose the Just Hypnotize Me option if you would just like to experience hypnosis for whatever happens to be bubbling up for you today. Recording available upon request.
Insurance: I suggest you think of my services as something that you will pay for personally, however, check with your insurance company about their coverage. I am happy to submit a claim on your behalf if you provide me with the form. In the case of smoking cessation, ask your employer or insurance company if they will reimburse you.
My Approach: I use the very effective tool of hypnosis to assist everyday people with everyday problems like Stress and Anxiety Softening, Focusing Techniques, Smoking Cessation, Weight and Wellness issues, and other compulsive habits and self-defeating behaviors. I assist the client to access his/her subconscious mind, and to replace negative thoughts and programming with positive suggestions that motivate and inspire the changes he/she desires. I teach all clients to do Self-Hypnosis so they can reinforce those suggestions so that they will become a permanent part of their present and future.
Client Signature: I have read the preceding information, it has also been provided verbally, and I understand my rights as a client or as the client’s responsible party.
__________________________________________
Client’s name Date
__________________________________________
Client’s Signature Date
If signed by Responsible Party, please state relationship to client and authority to consent: _____________________________________