Prior to our session, please click on the link to complete and securely submit your intake form online.  Once received, I will acknowledge receipt.  

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


Adults – please complete and submit this form with your information prior to your consultation or first session.

Parents of Child Clients – please complete and submit this form with your information prior to our Consult or Parent Foundation Session (one form per person attending the consult/session.)   Please do not put your child’s information on this form.  Please use the Consent to Perform Hypnosis on a Child form below for information pertaining to your child.

COMPLETE FORM ONLINE NOW

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

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

Parents of Child Clients – Prior to our Consult or Parent Foundation Session, please complete and submit the Adult Client Intake Form above with your information (one form for each adult attending the consult or session).  Then, please complete and submit this form with your child’s information.

COMPLETE FORM ONLINE NOW

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

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

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.

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