Client Consent & Agreement Form
Grounded and Rise Client Consent Form
(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
In these circumstances, the necessary information will be shared with the relevant authorities such as but not limited to GP and social services.
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.
Consent to Process Health-Related Information
I understand that, in order to receive hypnobirthing and antenatal education services, I may need to share information about my health, pregnancy, or medical history. I understand this is classed as special category data under UK GDPR, and I explicitly consent to Grounded and Rise (E. OD Healthcare LTD) collecting and processing this information for the purpose of providing my sessions, in line with the Privacy Policy. I understand I can withdraw this consent at any time.
Client Signature: _____________________________
Date: _________________________________
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: ___________________________
Address: ______________________________
Email: ________________________________
Phone Number: _________________________
10. Consent Confirmation
Signature: _____________________________
Date: _________________________________
11. Practitioner Copy
Signed on behalf of Grounded and Rise (E. OD Healthcare LTD)
Name: _______________________
Signature: _____________________________
Date: _________________________________