Magically Spiritual Hypnotherapy Application

Hypnotherapy Intake Form

Note: This is where you can book a hypnotherapy session with us. After filling out the form, you will receive an e-mail in 24 to 48 hours. Thank you for your patience.

Date of Birth

Location of Birth

Time of Birth (If you don't know it, leave blank.)

Have you experienced hypnosis or hypnotherapy? Describe.

Have you ever been diagnosed with any medical or mental health condition? If so, please list the diagnosis/diagnoses.

For remote sessions, you must have a headset with an in-built microphone, a cam and wifi that's stable for 90+ minutes is required. Do you have these things?

What issues do you want to focus on now? What issue is your priority?

List any additional comments you want to add below:

AGREEMENT

The purpose of hypnotherapy is to support vocational and avocational self-improvement and to serve as an alternative or complementary approach alongside licensed healing arts services. A hypnotherapist is not a licensed physician or psychologist. Hypnotherapy itself is not a state-licensed practice. Hypnotherapy is non-diagnostic, and does not involve the practice of medicine. Hypnotherapists may assist clients with goals. This does not replace medical advice. Clients are encouraged to consult with their physician before making any medical, health or lifestyle changes. Hypnosis works with the subconscious mind which is believed to influence habits, emotions, motivations and attitudes. Through hypnosis many people experience positive changes in behavior and mindset. Sessions are structured around the client’s needs and may require an undetermined number of visits. The hypnotherapist will make every reasonable effort to support the client’s goals. However, the effectiveness of hypnosis varies from person to person and no specific results or progress can be promised or guaranteed. Experiences in hypnosis differ for each individual. Some remain fully aware while others notice heightened awareness, vivid sensations or an enhanced imagination. Many describe deep relaxation and relief from stress while still feeling alert and in control. Hypnosis may bring up memories or images of past events. Without supporting evidence, one may not be able to confirm the accuracy of such memories. While hypnotherapists generally maintain confidentiality, information shared during sessions is not protected by psychotherapist-patient privilege. In certain circumstances a court may order disclosure. I acknowledge that I have received and understand this disclosure. I have also reviewed the accompanying biography outlining the hypnotherapist’s education, training, experience and qualifications.

HYPNOTHERAPY INTAKE FORM

This is where you can book a hypnotherapy session with us. After filling out the form, you will receive an e-mail in 24 to 48 hours. Thank you for your patience.

Date of Birth

Location of Birth

Time of Birth (If you don't know it, leave blank.)

Have you experienced hypnosis or hypnotherapy? Describe.

Have you ever been diagnosed with any medical or mental health condition? If so, please list the diagnosis/diagnoses.

For remote sessions, you must have a headset with an in-built microphone, a cam and wifi that's stable for 90+ minutes is required. Do you have these things?

What issues do you want to focus on now? What issue is your priority?

List any additional comments you want to add below:

AGREEMENT

Magically Hypnosis

Magically Hypnosis

Hypnotherapy Intake Form

HYPNOTHERAPY INTAKE FORM

Hypnotherapy Intake Form

HYPNOTHERAPY INTAKE FORM

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