Hypnotherapy Client Forms

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Prior to our session, please download and complete the forms that pertain to your visit.  You may email these back to me or bring them with you to your first visit.  

New Adult Client Intake Form – Required for all new hypnotherapy clients.  

New Adult Client Intake Form

To download the form, click the link.  A new page will open and allow you to download or print the file.   (4 Pages)

Please complete and submit prior to your consultation or first session.  If you are a parent of a prospective child client, please complete this form prior to your Parent Foundation Session.

Please complete one form for each parent or guardian attending.

New Child Client Consent Form – Required for all new child clients.  

Consent For Minor To Have Hypnosis

To download the form, click the link.  A new page will open and allow you to download or print the file.  (1 Page)

Parents:  please complete the above New Client Intake Form prior to our consult and also the Minor Consent Form prior to your child’s first session.  You may also require the Medical – Mental Health Referral form below depending on the child’s issue.

Medical – Mental Health Referral Form – Required for diagnosed conditions.

Medical – Mental Health Referral Form

To download the form, click the link.  A new page will open and allow you to download or print the file.   (2 Pages)

Whether diagnosed or undiagnosed, the State of Florida may require some issues to require a referral from your doctor prior to moving forward. (It’s also in your best interest to check with your medical professional first so as to rule out a more serious issue.)  Please download and forward this form to your primary care doctor or mental health professional. Please advise that I would be happy to clarify the process and discuss how hypnosis will help you resolve your issue.  Read more about how I work with Medical and Mental Health Issues here.

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