New Client Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

New Client Form

Suggestive Lifestyle Hypnosis

Email *

Today's date *

YYYY

First and Last Name *

Address

Home/Work Phone *

Occupation

Have you ever been treated for emotional problems? *

Yes

Unsure

Other:

Have you ever been treated for, or do you suffer from any health problems or have any known allergies? *

Yes

Other:

What do you wish to accomplish in/with these session(s)?

Any previous efforts to make this change? *

Yes

Have you ever been hypnotized before? *

Yes

Other:

I realized that Gabriel Saunders CH, Consulting Hypnotist, is an educator, hypnotist, energy healer, and life coach not a medical doctor or psychologist, and that he cannot diagnose disease, prescribe, or treat medical conditions or serious disorders. I understand that the services or training I am receiving from Gabriel Saunders CH is not asubstitute for normal medical care and I have been advised to discuss this procedure with any doctor who is taking care of me now or in the future. Additionally, I should conginue any present medical treatment and consult my regular physician for treatment of any new or old illnesses. I am willing to be guided through various methods, including relaxation, visual imagery, creative visualization, hypnosis, Ho'oponopono counseling, Neurolinguistic Programming (NLP) and stress reduction processes for the purposes of vocational or avocational self improvement. I also agree that Gabriel Saunders CH or myself may terminate this relationship at any time for any reason. *

You don't have to answer this question just continue to the next

Acknowledged

Not Acknowledged

I realize that although Gabriel Saunders CH has considerable training and many years of experience, the insights and service he provides, are not a cure, and I accept that I am paying for his expertise and insights irrespective of any particular result. *

DONE

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms