Intervention Consent Form

This is an intervention session with Anil Thomas. This form will only ask for your basic information. Your privacy and confidentiality will be upheld regarding any information you share on this form. Anil Thomas is a Master NLP Trainer and Gestalt Practitioner. This intervention offers a safe space for you to understand and work with increasing your awareness. Please read the following information carefully before providing your consent for one-on-one intervention sessions with Anil. Your well-being is our utmost priority, and we are committed to providing a safe and supportive environment during your intervention sessions with Anil. However, it is important to understand the following:

Terms and Conditions

Emergency Situations: Please note that our services are not intended for emergency situations. If you require emergency assistance, kindly look for alternative emergency services.

Clinical Diagnosis/Treatment: These intervention sessions are not a substitute for clinical diagnosis or treatment.

Time and Duration: Each session is 55 minutes in duration.

Payment: Please be aware that fees are non-refundable & non-transferable to another person or another slot under any circumstance.

Session Continuation: Both you and Anil are welcome to discontinue services at any time if either party feels uncomfortable. We want to ensure that everyone feels at ease and respected throughout our engagement.

Legal Obligations: We are required to notify the appropriate authorities/ emergency contact if there is any indication of harm to yourself or others.

Age Requirement: Our services are available only to individuals aged 21 and over. We cannot be held responsible for any inaccuracies in the information provided by clients, nor for any outcomes if the client is underage.

By agreeing to these terms, you acknowledge and consent to making the full payment in one transaction which is 10000/- INR.

By participating in the intervention sessions with Anil, you acknowledge that you understand and agree to these terms and conditions. We are here to support you, and we encourage open communication to ensure the best possible therapeutic experience.

Full name (Please enter the name of the person who is attending the session)

Contact number

Your email address

Please provide us with an emergency contact (name and number)

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Intervention Consent Form

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