New Client Welcome Packet - Change Your Frequency Hypnosis

Change Your Frequency Hypnosis

New Client Welcome Packet

Thank You for Choosing Change Your Frequency Hypnosis

Welcome to Change Your Frequency Hypnosis Please read and sign this form before completing the rest of the forms. We do our very best to ensure that we provide the highest quality hypnosis services available. We do this by constantly improving our techniques and keeping up with the latest developments in the field of hypnosis. The hypnotist that will be working with you is certified by the National Guild of Hypnotists.

As one might expect, there is some variation in the length of sessions. We try to keep to a strict schedule, but sometimes we may run late. Please excuse us if we do. Sometimes continuing a session for another 10 or 15 minutes can save a great deal of time in the long run for the client. Or, stopping the session at a particular time, may be inappropriate because the issue being dealt with is emotional, and the client needs some time to regain composure before returning to the waiting area. So, sometimes we will run a little late. Note that it is usually for a good reason.

Lastly, hypnosis is a very powerful process that has helped thousands of Americans to make the kinds of changes that they want to make in their lives. However, hypnosis is not mind control. For example, no one, not even the very best hypnotist, could make you lose weight, or stop smoking if you really don't want to. Nor could he or she accurately predict how many sessions it will take. Most people (but not everyone) begin to experience the benefits (from the very first session) and most people are done in four to six sessions. Ultimately, you are responsible for the changes that occur as a result of the hypnosis sessions.

This is both "good" and "bad". It is "good" because, after you have made the changes that you want using hypnosis, you deserve a great deal of the credit, and this knowledge helps you to make more changes in your life. But, on the other hand, it is bad because we cannot guarantee that the changes will come about. In fact, this is true in any situation where a professional is trying to help you. There is always a human factor. Doctors don't guarantee that you will get well. Teachers can't guarantee that you will learn, and lawyers can't guarantee that you will "win" your case. What we can guarantee, here at Change Your Frequency Hypnosis, is the very best service, using current information and appropriate hypnotic techniques for your situation.

Clients must make any changes (e.g. rescheduling or canceling their appointment) at least three weeks before their appointment or they will be charged for the appointment.

By signing this, I am stating that I have read this form and understand that, like the other healing arts, the practice of hypnosis is not an exact science: Therefore, results are not guaranteed, nor are refunds given for services rendered.

Welcome Agreement

Signature *

Date *

Confidential Client History Form

This form is to be completed before or at the initial session.

Please fill out this form and read the Client Bill of Rights below. Signing this form indicates that you have read that information.

Personal Information

Name *

Home Phone

Cell Phone

Address

City

State

Zip

Date of Birth *

Age

Pronouns

Marital Status

Occupation

No. of Children:

How You Found Us

How did you hear about us?

Google

Social Media

Newspaper

Other Advertisement

Personal Referral

If so, who referred you?

If you were referred by a medical professional, do we have your permission to discuss your progress with him/her?

Yes

Previous Hypnosis Experience

Has anyone ever tried to hypnotize you?

Reason:

Do you believe that you were hypnotized?

Why?

Generally, how did it go for you?

Your Current Goals

Reason you are coming for hypnosis *

Any previous attempt to address this issue?

Yes

Results

We find it useful to sometimes use a holistic approach (mind-body-spirit) when appropriate.
Would you consider yourself a spiritual person? (Circle One)

Yes

Maybe

Medical History

Current Medical Care

Are you currently undergoing medical or psychological treatment for the above issue (reason you're coming in)?

Yes

If so, where?

Dr.'s name?

Have you been under a doctor's care in the past year?

Yes

If "yes", please give reason

Dr.'s name?

Mental Health History

Have you ever been treated for emotional problems?

Yes

If "yes", are you currently receiving treatment or counseling?

Yes

By whom?

Health Conditions & Medications

Have you ever been treated for?

Heart

Diabetes

Epilepsy

Pain

Are you currently taking any medications?

Yes

If so, what

Reason for medication?

Have you had any prolonged illness?

Yes

If "yes", what illness

Do you have any questions about hypnosis?

Yes

Sessions at Change Your Frequency Hypnosis are video recorded, and become part of your confidential record.

Any appointment changes need to be made three weeks in advance. Appointments broken or canceled without the three weeks' notice will be charged for the session. Thank you.

Client History Form Agreement

Client Signature *

*Parent/Guardian Signature
(Required if client is under 18 years old)

Client Bill of Rights

Change Your Frequency Hypnosis
411 Walnut Street #22454
Green Cove Springs, FL 32043
(470) 394-4761

By law I am required to disclose certain information to my clients. This is for your protection.

I have been trained in hypnosis and am certified by the National Guild of Hypnotists. Change Your Frequency Hypnosis is a company registered in the state of Florida and complies with all laws and regulations therein.

In my practice I use hypnosis to help people discover the subconscious reasons for their symptoms, behaviors, or habits. When they are discovered, I use certain tools and techniques to help the client release them and relearn a new positive way of thinking, subconsciously.

Payment is expected at or before the time of the session.

The session is confidential, this is your right by law, unless:

You have given written consent stating otherwise.
You confess of a major crime or felony (no one can make you divulge secrets under hypnosis).
You are a minor, and there is physical evidence of abuse.
There is a subpoena for court relating to this session.
Or if there were charges brought against me for unprofessional conduct as described under Florida law.

Florida Hypnosis Disclosure: Hypnosis is a complementary approach that works alongside conventional medical care. I am not a licensed medical or mental health professional, and hypnosis is not a substitute for medical diagnosis, treatment, or care from licensed healthcare providers.

Client Rights Acknowledgment

I have read and understand my rights.

Client Signature *

Date *

If you are a minor, you must have a parent or guardian signature.

Making Appointments, Missed Sessions and Rescheduling Policies

Making Appointments Policy

We require a credit card number or an advanced payment (check/cash) to hold and confirm an appointment
All deposits for services are non-refundable

Cancellations, Missed Appointments and Rescheduling Policy

Schedule Changes:

We do our best to accommodate all requested schedule changes
All changes must be made at least three weeks before the day of the appointment
No exceptions to this policy

Late Cancellation Policy:

Clients making cancellations, missing appointments or rescheduling less than three weeks before the appointment date will be charged for the time scheduled
This charge applies because we will be unable to utilize that time to schedule in another client upon such short notice

Why This Policy Exists:

To ensure that our appointment times are being best utilized
Many clients are needing to wait 6-8 weeks to come in
With enough advance notice, we are able to schedule our clients efficiently
This ensures better use of our hypnotist's time
Hypnotists better serve our clients when appointment times are being kept

We thank you for your understanding and we look forward to serving you.

Appointment Policy Agreement

I have read and understand the appointment policy.

Client Signature *

Date *

Benefits Form

Thank you for choosing Change Your Frequency Hypnosis. Please fill out this form. The information will be helpful during your session.

What is the reason you're coming in for hypnosis today (the change you want to make)?

Please list seven of the benefits you expect to gain from making the change you would like to make?
Benefits of making the change you want

Check as many of the following as it applies to you, and fill in the blank space if appropriate.

I often feel that I should be punished for something I once did.

I know of a past experience or relationship that could be causing this problem.

I am aware of an internal conflict that may be causing part (or all) of my problem.

If I get better, I stand to lose:

If I wasn't so much like ________, I'd be much happier.

Write down any questions you have here:

Name

Date: *

Complete Your New Client Welcome Packet

Thank you for taking the time to complete this comprehensive intake process. Your information helps us provide you with the most effective hypnosis program possible.

Change Your Frequency Hypnosis

411 Walnut Street #22454, Green Cove Springs, FL 32043

Phone: (470) 394-4761

Transforming lives through the power of hypnosis