• Client Intake & Medial History

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  • About your session

  • If you have any questions about your session or hypnosis, please ask! We will explain the hypnotic process in depth prior to your session. If you wear hard contact lens or glasses, please remove them before your session as they inhibit your ability to relax. Hypnosis benefits are proven to be effective, however, there are no guarantees as expectations and results are relative to client responsibility and commitment to succeed. Hypnosis is 80% effective in applications for behavior improvement and stress management necessary to good health and well-being.

     
    Hypnosis is a powerful tool that utilizes the resources of your mind and body to benefit you. Its benefits are relative to your participation, similar to that of a physician who prescribes medication / treatment; it works if you use it.

     
    As a Hypnotherapist, we:

    1.) do not diagnose, treat or cure disease,

    2.) do not assess or evaluate Medical information,

    3.) will determine if we are trained to work with your specific issues and, if not, will refer you to other professionals, and

    4.) are trained and certified in the skills of hypnosis and its beneficial applications.

     

    Because of the personal growth nature of our practice, we ask you to speak from a place of responsibility, based on the choices you made leading up to the event you are faced with. We understand there are “reasons” for events in your life. Please remember that you always have a choice. We can help you to be as comfortable as possible while describing your issues honestly and openly, for your best outcome.

  • All client information is strictly confidential*


    * Important: Hypnotherapist and client relationship responsibilities include the following statement of understanding: If we are presented with information that may be illegal or threat of harm to you or others, (e.g. suicide, child abuse, etc.), we are legally obligated to report this possibility to the proper authorities.

     
    I understand the hypnosis session I am about to receive is NOT a medical or psychological procedure. I also understand my session may be audio or video taped. Therefore, you hereby have my consent and authorization to record my session. I further understand that during the in person hypnotherapy session, the Hypnotherapist may touch my arm, shoulder, foot or forehead as an anchoring technique for the hypnotic suggestions provided during my session. I hereby give my permission for such touch to take place during the session.

     
    I agree to provide a 48-hour cancellation notice in the event I cannot make my scheduled session appointment(s).

    I further understand I will be financially responsible for the session fee in the event I fail to arrive (or arrive more than 15 minutes late) for my scheduled session appointment(s).

     

    I have read, understand and agree with the above information:

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