I hereby authorize Vanessa Wawrzynowicz, CHT, Hypnosis Coach, to hypnotize me for the purposes outlined in this intake form. I understand that the success of my hypnosis coaching sessions depends greatly on my own ability to relax and desire to create change in myself. I understand that because the results of my sessions depend in part upon my own serious participation, that Vanessa Wawrzynowicz CHT, Hypnosis Coach, cannot offer any guarantee of the success of my treatment. I am aware however, that Vanessa Wawrzynowicz CHT will do everything reasonably in her power to ensure my success. Client acknowledges understanding this questionnaire, and all information provided is accurate and complete to the best of the client’s knowledge and that hypnosis coaching is a healing modality working alongside, not instead of therapeutic and/or medical care.