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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.

- 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.

Generally speaking, the information provided by and to the client during therapy sessions is legally confidential and cannot be released without the client’s consent. There are exceptions to this confidentiality, some of which are listed in section 12-43-218 of the Colorado Revised Statutes as well as other exceptions in Colorado and Federal law. For example, mental health professionals are required to report suspected child abuse to authorities. If a legal exception arises during therapy, if feasible, you will be informed accordingly. The Mental Health Practice Act (CRS 12-43-101, et seq.) is available at: http://www.dora.state.co.us/mental-health/Statute.pdf.

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.

See the button for services and programs below.

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.


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Client’s name                                                                                       Date


________________________________________________________________________  _________________
Client’s Signature                                                                               Date
If signed by Responsible Party, please state relationship to client and authority to consent: ___________________________________________________________