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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!

QUESTIONS OR NEED A BOOKING?

27 Meath Hill Road, Pembroke

ON, K8A 6W3

​​Tel: 416.571.3081

​contact@angelasolorzano.com

Internationally Over ZOOM and In Person

Check "Locations" for more info.

REGARDING?

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​Disclaimer: Hypnosis and/or Reiki is not intended to cure any specific condition. I make no claims of a cure for any disease. Success is dependent on ​the client's belief system​.
Copyright© 2024 by Angela Solorzano. 
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