Client Information and Participation Agreement

Client Hypnotherapy Intake Form

Client Information and Participation Agreement This information will be used to aid in serving you as the client. Please answer honestly and know that answer yes or no to any particular question does not mean that you cannot receive services from this practitioner. Your honest answers serve in your receipt of appropriate care and services. All information will be kept confidential with the Accountability Act (HIPAA) regulations.

Is it ok to leave a message and text to this number? *
Is it ok to email this address? *
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Tanya Fuller, Hypnotherapist, CMS-CHt, FIBH