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Confidential New Client Form (Hypnosis, Regression)

Please read the section below, below clicking “submit” 

Some important things to know: 

Are you wearing contact lenses? Your eyes will be closed for about 45 minutes. If your contacts will cause eye irritation, you may want to bring your lens holder and solution so you can remove them just before hypnosis.

Medical Hypnosis. Before we start medical hypnotherapy session, which includes chronic pain, I require a signed permission from your healthcare provider stating that there are no contraindications to use hypnotherapy in your case.

My Guarantee:  Immediate results are possible, but are not guaranteed. Some people achieve the desired results after 1-3 sessions. Certain challenges naturally take longer to transform, and we may need to incorporate coaching and energy work for a long lasting success.

Factors that will influence your success: 1) how much do you desire the change, 2) is it truly your intent. If it ‘s your family member that wants you to change more than you do – you probably won’t get their results. 3) hypnotherapy works when you release the need to control the process or analyze it, when you relax and let go.

You will experience stress release and a wonderful, deep relaxation.

Questions? I’m here to answer any and all questions you may have about our work.  My goal is to get you maximum results in the minimum number of sessions.  We are more likely to achieve it when you are completely calm, confident and trusting the process.

By submitting this form you acknowledge:

I am fully informed of a nature of hypnosis / hypnotherapy (also knows as: guided imagery, guided meditation) and I am willing to be guided thru the visualization, relaxation and stress reduction techniques. I understand that it is NOT: counseling, advice, or therapy.  If the program address health issues, I will NOT make any changes in my medications without consultation with my healthcare practitioner.


Code of ethics is available at:  http://hypnotistexaminers.com/code.html   American Council of Hypnotist Examiners 700 S. Central Ave. Glendale, CA 91204    phone: 818-242-1159