1) Business Information: Practitioner name:  Kelly Meissner MS, LMFT, CH. Business name: Hypnotherapy With Kelly LLC. Address: 15 South Minnesota Street, New Ulm, MN 56073  Phone: 507-291-8444. Email: kelly@hypnotherapywithkelly.com. Website: hypnotherapywithkelly.com.
                                         
2) I hold a Master’s degree in Mental Health Counseling from the University of Minnesota, Mankato. I am licensed by the Minnesota Board of Marriage and Family Therapy. My license number is #2664. I became Certified in Hypnotherapy by the National Guild of Hypnotists in 2016 and have extensive clinical hypnosis training through the Minnesota Society of Clinical Hypnosis. I have a total of 194 hours of education  training in hypnosis. "THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLIMENTARY AND ALTERNATIVE HEALTH CARE. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATION PURPOSES ONLY. "Under Minnesota law, an unlicensed complementary and alternative health care practitioner may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or services from a physician, chiropractor, nurse, osteopath, physical therapist, dietitian, nutritionist, acupuncture practitioner, athletic trainer, or any other type of health care provider, the Client may seek such services at any time.” Minn. Stat. 146A.11Hypnotism is a self-regulating profession and its practitioners are not licensed by state governments. The Practitioner is not a physician and may not provide a medical diagnosis nor recommend discontinuance of medically prescribed treatments.

3)  I am not required to operate under supervision for hypnotherapy as complementary and alternative health care.  

4-5) Redress: The Client has a right to file a complaint with the Practitioner. I am a certified member of the National Guild of Hypnotists, and practice in accordance with its Code of Ethics and Standards. If the Client has a complaint about the Practitioner’s services or behavior that the Practitioner cannot resolve for the Client, the Client may contact the National Guild of Hypnotists at P.O. Box 308, Merrimack, NH 03054-0308, (603) 429-9438, to seek redress. Additionally, if the Client has a complaint or concern about the care or services they have received, the Client may also contact the Office of Unlicensed Complementary and Alternative Health Care Practice located in the Minnesota Department of Health, PO BOX 64882, St. Paul, MN, 55164-0882. Telephone: 651.201.3728. Fax: 651.201.3839. Website: www.health.state.mn.us Redress options for the Minnesota Board of Marriage and Family Therapy: You can examine my credentials and receive a copy of the code of ethics in the public records maintained by the Minnesota Board of Marriage and Family Therapy at 2829 University Avenue SE, Suite 400, Minneapolis, MN 55414 and report complaints at 612-617-2220.              
6) Service Duration, Fees and Payment Information: The Client has a right to complete and current information concerning the Practitioner's assessment and recommended service that is to be provided, including the expected duration of the service to be provided. Program and payment options are fully discussed during the initial consultation. Hypnotherapy sessions typically take 90-120 minutes and will not exceed 120 minutes. If a person is needing more than 120 minutes, that is an indicator that a minimum of another session is recommended for best outcomes. Consulting sessions are 50 minutes.  Professional Fees/Finance Charges: Payment is due in advance in order to secure appointment time. 15 minutes phone or zoom consultation is Free. Consulting session is $60.00. Hypnotherapy session is $150.00. Discounted package options are not only the best value, they are the best option for creating the lasting change you seek.  Discounted Package is 3 sessions for $360.00. Accounts exceeding 30 days are subject to late fees and/or reporting to collection agency. There is a $25.00 service charge for returned checks. If for any reason information or time that is requested by means of a court order in adherence with state or federal rules, laws or regulations, you will be charged $300 per hour for this time. Fees and cancellations- I require a 2 business day (48 hour) notice of cancellation. For example, if the appointment is on Monday, in order not to be charged, the Practitioner must be notified no later than Thursday during office hours as I will be unable to utilize that time to schedule another client upon such short notice. The pre payment will not be refunded or the credit card will be charged the price of the service if the Client does not show up, or cancels or reschedules the appointment within the required two working day time frame (Monday - Friday). This policy is neither a penalty nor punishment. Attendance to your appointment is crucial for your outcomes and missed appointments can create an unnecessary financial burden for us both. I understand that unexpected events happen. In return, I ask for your understanding as well. If you contact me and we both agree you are unable to attend due to circumstances beyond your control, you may be able to reschedule with no penalty. Please note that there are very few exceptions to this policy. Because I work with processes and programs that span varying lengths of time, the Client agrees to complete all program visits in order to receive the greatest benefit. If for any reason the Practitioner determines the Client will not benefit by continuing to complete the program, a refund of the remaining unused sessions may be provided. Refunds are not given if the client decides not to continue.- Appointments are scheduled for approximately 75-90 minutes.- I accept cash, check, Visa, MasterCard, Discover and American Express. Payment plans may be arranged upon request.- I do not accept insurance. In general, insurance companies do not cover hypnotic services. If you need mental health treatment, meet criteria for a mental health diagnosis and want to use insurance, it may be more appropriate for you to seek my mental health services through the New Ulm Medical Center. - Receipts of service are provided upon request so the Client may apply for ‘Flex-Pay’ or Health Savings Account reimbursements if they are applicable. Nondiscrimination: No person may be denied services because of the person’s sex, race, religion, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional or learning disability.                      

7) The Client has right to reasonable notice of changes in services or charges.

8) Theoretical approach for provided services: Hypnosis helps ordinary, everyday people with ordinary, everyday problems using individual hypnotic tools and techniques. It helps people discover within themselves the resources necessary to accomplish their goals, overcome limiting beliefs, and create helpful habits and thoughts in relation to their stated objective(s). The aforementioned coaching methodologies can help a person to powerfully and influentially communicate with themselves in an empowering manner, producing results that create a better life. Hypnosis can have a significant, positive impact on a person if they desire the changes they seek and agree to fully engage in the change process. This work can be an incredibly healing and rewarding experience. Ideally, it will result in alleviation of symptoms, more satisfying relationships, and improved functioning in all life domains. However, during sessions, clients may have to deal with painful emotions and/or the surfacing of unpleasant memories, events or situations. I can never guarantee any particular outcome for clients. Ultimately any change and/or decisions made during the course of therapy are the responsibility of the client. I will never practice outside the scope of my training. In the event I am not able to provide you with the services you need/desire or it is determined that you need mental health treatment,  I will help you find those services and discuss the risks and benefits of these alternatives.

9) The Client has the right to complete and current information concerning my assessment and recommended service that is to be provided, including the expected duration of the service. See section 6 for more details.  

10) The Client has a right to be free from verbal, physical, or sexual abuse by the Practitioner. I promise to always treat the Client in a courteous and professional manner, and to use the methodologies that best meet the Client’s objectives. The Client agrees to fully engage in the processes and program in order to achieve the best results and pay the agreed upon fee.  

11) Confidentiality: As a rule, your health information is personal and it will not be disclosed, or that you are my client, without your written consent. However, you have the right to revoke your permission, in writing, at any time, by contacting me. Limits to Confidentiality There are some important exceptions to this rule of confidentiality. I may disclose Protected Health Information without your consent or authorization in the following circumstances: Emergency: If you are involved in a life-threatening emergency and I cannot ask your permission, I will share information if I believe you would have wanted me to do so, or if I believe it will be helpful to you. Child Abuse Reporting: If I have reason to suspect that a child is abused in any way or neglected, I am required by Minnesota law to report the matter immediately to the Minnesota Department of Health and Human Services. This includes but not limited to physical/verbal/mental abuse, sexual abuse, prenatal exposure to controlled substances used for nonmedical purposes, or habitual or excessive consumption of alcohol during pregnancy. Adult Abuse Reporting: If I have reason to suspect that an elderly or incapacitated adult is abused, neglected or exploited, I am required by Minnesota law to report the matter immediately to the Minnesota Department of Health and Human Services. Serious Threat to Health or Safety: If you communicate to me a specific and immediate threat to cause serious bodily injury or death to yourself,  to an identified or to an identifiable person, and I believe you have the intent and ability to carry out that threat immediately or imminently, I am legally required to take steps to protect you or others. Health Oversight: I may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. If you report misconduct by health care provider of any profession, I am required to report such misconduct. If you are yourself a health care provider, your relevant records in investigating a complaint of incompetence or misconduct my be subpoenaed by the State of Minnesota or professional governing board. Court Proceedings: If you are involved in a court preceding and a request is made for information about your treatment thereof, such information is privileged under state law, and I will not release information unless you provide written authorization or a judge issues a court order. Protections of privilege may not apply if I do an evaluation for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case. Workers Compensation: I may disclose protected health information regarding you as I am required by law, upon request, to submit your relevant mental health information to you, your employer, the insurer, or a certified rehabilitation provider. Records of Minors: Parents, regardless of custody, may not be denied access to their child’s records. In civil commitment cases, court appointed individuals such as a Guardian Adlitum have legal access to information without notification or consent of parents or child. Minnesota Board of Marriage and Family Therapy: Information that is requested by the Minnesota State Marriage and Family Therapy Licensing Board involving disciplinary proceedings of your practitioner or information requested by parties taking legal action against your practitioner. In the event of a client’s death: The spouse or parents of a deceased client have a right to access their child’s or spouse’s records. In order to protect confidentiality: Should a practitioner encounter a client in public he/she will not acknowledge him/her as such unless the client initiates contact. In order to provide the best possible care: practitioners seek consultation from time to time from other colleagues. In these times, all identifiable information is disguised to protect your confidentiality. Other uses and disclosures of information not covered by this notice or by the laws that apply to me will be made only with your written permission. You may reopen this conversation at any time during our work together.  
12) Your care requires me to keep information related to you and your treatment. I am committed to protecting your information. The Client has a right to the information in accordance with sections 144.291 to 144.298. Minnesota State law provides that you may review the information contained in your record. However, it also provides that if your practitioner believes the information could be detrimental to a client’s physical/mental health or wellbeing, you may not be allowed to review the information. Patient information will be kept for at least seven years from the date of last treatment. Thereafter, patient records will be destroyed. When records are destroyed, they will be destroyed in a manner that protects patient privacy and confidentiality.

13-17) Right to Choose: The Client has a right to other services of this nature. I have the right to refuse working with a Client who I cannot serve properly or may be uncomfortable with for any reason. In this case, I will recommend another practitioner if able. In the event services are terminated by the Client or Practitioner, the Client has a right to coordinated transfer of services to another practitioner. The Client has a right to discontinue services at any time, subject to the payment terms listed above. the Client has a right to know the expected duration of sessions, and may assert any right without retaliation. Acknowledgment by Client Prior to the provision of any service, the Client must sign a written statement attesting that the Client has received, read and understood this Complementary and Alternative Health Care Client Bill of Rights Confidentiality and Informed Consent provided by Hypnotherapy With Kelly.