Adult Medical Intake Form

DISCLAIMER: The Hypnotist is not a healer. The Hypnotist can only facilitate the session. Hypnosis is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or of other qualified health providers with any questions you may have regarding a medical condition. All the information you provide below, is private and protected. The following questions are only to better prepare me, the practitioner, for the hypnosis session. The more information I know, the better the experience.

Have you ever been hypnotized?
Please select one option.
Are you currently taking any medicine?
Do you live with any of the following?

I will reach out shortly!