Client Consent & Agreement Form

Grounded and Rise

(E. OD Healthcare LTD – Company No. 15932569)

1. Practitioner Information

I understand that services are provided by Grounded and Rise, the trading name of E. OD Healthcare LTD.

I acknowledge that the practitioner is a Registered Nurse with the Nursing and Midwifery Council (NMC). However, I understand that all services provided under this business are delivered in a non-clinical, independent capacity and are not provided as part of any nursing role, NHS employment, or clinical healthcare service.

2. Nature of Services

I understand that hypnobirthing, relaxation-based techniques, coaching, and antenatal education services are:

  • Educational and supportive in nature

  • Designed to promote relaxation, confidence, and birth preparation

  • Not a substitute for medical care or medical advice

  • Not a form of diagnosis, treatment, or medical intervention

3. Medical Responsibility

I understand that:

  • I remain responsible for my own medical care and decision-making

  • I will continue to seek advice from my GP, midwife, obstetrician, or other healthcare professionals as appropriate

  • I will not delay or discontinue medical treatment based on information received during sessions

  • No medical advice is being provided during sessions

4. Scope of Practice (Registered Nurse Clarification)

I understand and agree that:

  • The practitioner is acting solely in a hypnobirthing, education, and wellbeing capacity

  • The NMC registration is not being used to provide clinical assessment, diagnosis, or treatment

  • No nurse–patient relationship is formed through these services

  • All support provided is outside of NHS or clinical practice

5. Personal Responsibility

I understand that:

  • Results from hypnobirthing and relaxation techniques vary between individuals

  • I am responsible for my own participation and experience during sessions

  • I will inform the practitioner of any relevant medical, psychological, or pregnancy-related conditions that may affect my participation

6. Confidentiality

I understand that information shared during sessions will be kept confidential, except where:

  • There is a risk of harm to myself or others

  • Disclosure is required by law

  • Safeguarding concerns arise involving an unborn baby or vulnerable person

7. Data Protection

I understand that my personal data will be handled in accordance with the UK GDPR and the Data Protection Act 2018, as outlined in the Privacy Policy.

8. Consent to Receive Services

By signing below (or ticking agreement online), I confirm that:

  • I have read and understood this consent form

  • I understand the nature and limitations of the services provided

  • I voluntarily agree to participate in hypnobirthing and/or relaxation-based educational sessions

  • I understand that I may withdraw consent at any time

9. Client Details

Full Name: ___________________________

Date of Birth: _________________________

Address: ______________________________

Email: ________________________________

Phone Number: _________________________

Due Date (if applicable): _______________

10. Consent Confirmation

Signature: _____________________________

Date: _________________________________

☐ I agree to the above terms (if completed online)

11. Practitioner Copy

Signed on behalf of Grounded and Rise (E. OD Healthcare LTD)

Name: _______________________
Signature: ____________________
Date: ________________________