New Client Intake Form

*This form is to help me get to know you before your session. Please fill it out to the best of your ability. Our work together is to support your healing and self-discovery journey. Please note that our time together is not intended to medically diagnose or treat, as I am not a licensed medical professional.

First name

Last name

Phone

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Please tell me a little about why you are choosing to do a session at this time?

How did you hear about us?

Have you ever experienced hypnotherapy, past life regression, sound healing or energy work before? If so, please explain what kind and how it went for you?

Is there anything else that feels important to share before we meet?

By signing this document, I acknowledge the inherent risks from hypnotherapy, sound healing, and energy work and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.

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Harmonic Resonance Hypnosis & Sound Journeys

~Hypnosis to Harmonize Your Life~

New Client Intake Form