Methods Used: The services I render are held out to the public as non-therapeutic hypnotism, defined as the learning of self-hypnosis to induce positive thinking, create commitment to change and to learn the techniques of self-hypnosis to produce self-control over physical experiences and emotional awareness. I do not represent my services as any form of health care or psychotherapy, and I may make no health benefit claims for my services. Specific techniques may include Body Relaxation/Progressive Muscle Relaxation, Guided Meditation, Regression, Behavior Modification, and Guided/Visual Imagery. The Client understands that the above modalities are not substitutes for regular medical care, and has been advised to consult with his/her medical doctor of health care practitioner for treatment of any old, new or existing medical conditions. With any medical emergency or if I feel suicidal, I will call 911. Initials: