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Form #1

Healing Thru Hypnotherapy                                   

CONFIDENTIAL CLIENT INFORMATION FORM

ALL 4 PAGES MUST BE FILLED OUT IN FULL BEFORE A SESSION CAN BE CONFIRMED!!!

DATE: _______ / _______ / _______

First Name: _______________________ Last Name: ____________________________

 Address: ________________________________________________________________

 City: _________________________   State: _________ Zip/Postal Code: ____________

 Day Phone: ( ____ ) ______ - __________  Night Phone: ( ____ ) ______ - __________

E-Mail: _________________________________________________________________

Occupation: ______________________________   Date of Birth _____ / _____ / ______

 Do you have any medical condition (s) or psychological history that the hypnotist should be aware of before the hypnosis session?

YES __________   NO __________   Not Applicable __________

 If yes, please explain ______________________________________________________

If you are currently under the care of a doctor or psychologist, do you have their permission for a hypnosis session with a certified SBHTC hypnotist?

YES __________   NO __________    Not Applicable __________

Have you ever been hypnotized/regressed before? YES _____  NO _____ 

If yes, when, and describe your experience _____________________________________

________________________________________________________________________

 What do you wish to accomplish with this session? ______________________________
 
________________________________________________________________________

 What City are you registering for? ______________________________

What date do you wish to register for? ___________________________

Payment Information: (Circle one): Check / Money Order (credit/debit card acceptance not available at this time) 

Credit Card Number: _____________________________________________

 Expiration Date: _____ / _____ / _____   3 Digit Security Code: __________

Mailing address for credit card ______________________________________________

(If different from above)

 Check Number: __________________________                                                              

 

Form#2

HYPNOSIS EXPECTATIONS: PAST-LIFE REGRESSION

      Everyone experiences a Past Life Regression in their own way.  Frequently, people experiencing a session for the first time think they have “made up” their experience while in hypnosis, or feel they have imagined all of it.  But then little things will begin to happen that slowly provide validation to what you experienced.

      To get the most from your Past Life Regression, keep an open mind and don’t analyze your experience during the session.  You will have plenty of time for that later.  Simply let the information flow into your mind without questioning it.

     Most people have experienced clues as to their prior incarnations.  Are you drawn to a particular country, people or a specific time period, like the civil War?  If the Grecian architecture attracts your interest you may have lived in the time Greece flourished.

     The same is true if you feel negative about a nationality, a place or historic time period.  Your soul’s experience may not have been to your liking.  You may still feel the emotions of love, hate, rejection or any other emotion that relates to a past life.  We call these “past life carryovers” and they can directly relate to the life you are now living.  Any strong affinity or aversion is a clue.

     When the hypnotist instructs you to step through the light into a past lifetime you may experience one of several different reactions:


            *          You may see yourself quite clearly

            *          You may see quick impressions

            *          You may seem to “know” without seeing

            *          You may not see anything, but feel as if someone is telling you what is happening.

            *          Regardless of your initial reaction upon entering your own past, you will need to answer the questions as the hypnotist asks them.  Answer with the first response that comes to mind.  As the regression progresses, you will find the impressions become stronger.

     If you actively analyze the process while in session, you will only retard the

impressions.  Your mind is on a journey through your soul’s experiences of lifetimes. Let

it travel freely.  Analysis can wait until your session is finished, after you have collected

all the data.


Signed by: ____________________________________________

 Date: __________ / __________ / __________

 


Form #3

HYPNOSIS REFUND POLICY

 The services provided by Healing Thru Hypnotherapy are highly speculative in nature, and we do not guarantee that the results of our work will be satisfactory to a client.  We reserve the right to refuse service to anyone.

If we have traveled to see you: Due to the non-refundable travel expense incurred to offer this service, no refund is available for a client who does not show up, or is late for their appointment.  It may be possible, but not guaranteed, to refund your fee, if you cancel your appointment within 7 days before your time slot, and we are successful in filling your time slot.

Full refunds are available if, and only if:

Healing Thru Hypnotherapy cancels or changes the appointment, which is not acceptable to the client, or and incomplete service is rendered.

 An incomplete service is defined as:

     *     The Hypnotist feels unable to effectively deal with the client’s personality, or problems to be resolved, or,

     *     The hypnotist is unwilling to continue working with a client for personal conflict of interest reasons, or,

    *     Clients present themselves unprofessionally, or in a manner that is unsafe to the well being of the hypnotist, staff or the general public.

 A service is fully completed when:

     *     A personal counseling or hypnosis session has gone on for thirty minutes.

 Non-Refundable:

No refund is given to any client who does not show up, or is late for their scheduled appointment.

Healing Thru Hypnotherapy uses the Sylvia Browne Hypnosis Training Center- and the Colorado Department of Regulatory Agencies to resolve all disputes.

I understand and accept these policies, and agree to abide by the specifics set forth by Healing Thru Hypnotherapy.

 

Signed By:

 ______________________________________________

 Date: _______ / _______ / _______

 

Form #4

 
HYPNOTHERAPY DISCLOSURE FORM

 WAIVER OF LIABILITY

By their signature below, the above named client voluntarily agrees to be the subject of a Hypnotherapy/ Spiritual Counseling session and accepts full responsibility for any and all injury arising from the Hypnotherapy/Spiritual Counseling session.  The client shall hold harmless all parties involved in the Hypnotherapy/Spiritual Counseling session including the Sylvia Browne Hypnosis Training Center, Healing Thru Hypnotherapy, Hypnotherapist, administrators, founders, directors and assistants.

 DISCLAIMER

THE HYPNOTHERAPIST IS NEITHER A TRAINED PSYCHOLOGIST NOR A MEDICAL DOCTOR.  At no time will the Hypnotherapist attempt to provide medical or mental health therapy.  The client affirms that hypnotherapy is appropriate for them and does not conflict with existing medical or psychiatric treatment.  Always follow the advice of your physician or other professional medical practitioner.

WARRANTY

No warranty is given, expressed or implied, for satisfactory results from the Hypnotherapy/Spiritual Counseling session.

 SESSION RECORDING

All personal services are recorded, at no charge, as a free service to the client.  We do not guarantee that the recording will be audible, fully intact, or usable.  We will not be responsible for nor issue refunds for defective or damaged recordings.

METHODS USED

The Hypnotherapist employs Hypnotherapy and Spiritual Counseling techniques to facilitate the client’s quest for self-improvement.  Specific techniques may include Body Relaxation, Directed Meditation, Age Regression, Cell Memory Theory, Spiritual Philosophy, Past-Life Regression, Behavior Modification, Psychic Insight, Psychic Healing and/or “Laying On” of Hands.

TRAINING AND EDUCATION

Hypnotherapy and Spiritual Counseling training provided by: Sylvia Browne Hypnosis Training Center, Campbell, California.


Signed by: _________________________________________________

 Date: _______ / _______ / _______