• CLIENT INTAKE FORM

    PRIVATE AND CONFIDENTIAL
  • Client Information

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  • Hypnosis History

  • Medical History

  • Please list seven benefits you expect to gain from making the change(s) you would like to make through the help of hypnosis.

  • Disclaimer

    Hypnotherapy complements conventional medical treatment and it does not cure or claim to cure medical conditions. For prevailing medical condition, clients are advised to consult their Physician prior to any hypnotherapy session.

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