Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastHome Address *Email *Best Number to reach you? *Preferred method of communication? * Cell phone Email Text All of the above How did you hear about Spry-Hypnotherapy, LLC? *The reason for your visit? *What Session are you interested in? *HypnotherapyPast Life/In Between LifeBreathworkHave you been in therapy before? *YesNoHave you ever been hypnotized before? *YesNoAre you currently taking medications, if so, please state for what reasons? *Do I have your permission to record your sessions? *YesNoAgreement: *YesNoAs I enter into this relationship, I agree to the following: I am participating in hypnosis by my own choice because 1 want to be here. I understand that I am not a patient, but a co-operator in my hypnosis experience. I understand that my progress here involves how I care for myself physically and mentally, emotionally, and spiritually. I understand success is dependent on many factors, one of which is being committed to the process. As such, the Facilitator may assign homework to which I agree to complete as part of the process. I understand that transformation is a process and that it can take time. Type Your Name *As your hypnotherapist, I commit to you that I will utilize all of my skills to help you to reach your goals in the shortest time possible. You have my assurance of my full integrity, professionalism, confidentiality, and respect. Please add any additional information you would like me to know about.Submit
