Fill out before your first visit

After you book your visit with a hypnotist or hypnotherapist, please fill out the paperwork below and bring it with you to the first visit. If you do not fill out the information before the first visit we cannot complete your session. Paperwork may be filled out in the first session, but this will reduce the time for your session and you will be billed at the full session price.

Children are not permitted to be left in the welcome area alone. If your child(ren) are not scheduled for an appointment, we ask that you leave them with a childcare provider in an alternative location, so that we might best serve our clients, including you.

Minors will need a parent or guardian present at the first session to fill out authorizations for treatment. Your counselor will instruct you as to their desire for your presence at the sessions that follow.

**There is a fee of $75 for any appointments that are canceled within less than 24 hours for a non-emergency and for any sessions that are not attended without a previously made phone call (no call no show).

Suggestibility questionnaire
Credit card form
Personal information
Acknowledgement of services
Life history questionnaire
Informed consent
Privacy notice

Request for Therapy Referral