• Hypnotherapy Intake Form

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  • Health History





  • Hypnotherapy Consent:

  • I consent and request to be guided through any combination of relaxation, guided imagery/visualization, hypnosis, stress reduction, and mindfulness techniques. I have been informed of the nature, safety, and usefulness of hypnosis. I understand that personal results will vary and there are no expressed or implied guarantees of specific results . I am also aware this is non-medical in nature and will consult my health care provider for any medication changes.

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