banner

Patient Information

If patient is under 18 years of age, enter guardian information below.

Emergency Contact Information

Health

PERSONAL INFORMATION

What to Expect in your Transform Now Hypnosis Sessions:

The hypnosis process takes from 50-70 minutes, approximately. It depends on the individual. It requires guiding you to a relaxed, comfortable place within yourself, using a series of relaxing breathing & visualization techniques, starting with what is known as “induction” and then various “deepeners” moving you directly into the subconscious mind where you are given hypnotic suggestions to help you to achieve your goals; you are fully aware and in control of your session at all times.

I hereby authorize Vanessa Wawrzynowicz CHT to hypnotize me for the purposes outlined in this intake form. I understand that the success of my hypnosis 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 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 is a healing modality working alongside, not instead of medical care.

Clear

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Transform Now Hypnosis

Vanessa Wawrzynowicz, Hypno-coach,MA, CHT

TransformNowHypnosis@gmail.com

720-470-2823