Hypnotic Therapeutics provides clinical hypnosis, clinical hypnotherapy and NLP services to inidividuals and corporate wellness programs. New Client Forms.
Providing clinical hypnosis and clinical hypnotherapy services to individuals, business, corporations and small businesses throughout the united states including; chicago hypnosis,atlanta hypnosis,milwaukee hypnosis,cleveland hypnosis,dallas hypnosis,austin hypnosis,houston hypnosis,nashville hypnosis,jackson hypnosis,shreveport hypnosis,new orleans hypnosis,st.louis hypnosis,madison hypnosis,denver hypnosis,baltimore hypnosis,charlotte hypnosis,kansas city hypnosis,omaha hypnosis,des moines hypnosis,albuquerque hypnosis,phoenix hypnosis,sacramento hypnosis,tucson hypnosis,los angeles hypnosis,oklahoma city hypnosis,tulsa hypnosis,memphis hypnosis,knoxville hypnosis,lexington hypnosis,san antonio hypnosis,taos hypnosis,santa fe hypnosis
David A. Blender, CPC, CCH, CH
847.868.0068
david@hypnotictherapeutics.com
Hours By Appointment Only.
Prior to meeting with Hypnotic Therapeutics for the first time, each client must complete a New Client Intake Form and Hypnotics Life History Questionnaire.
In addition, the following forms will need to be completed during your initial visit including, Disclosure of Services, Acknowledgement of Services and Fees, and in the event you have been referred to Hypnotic Therapeutics by a licensed medical practitioner, the Request For Medical Referral Form. These forms are fairly simple and not too time consumiong to complete.
The forms are necessary in order to obtain the appropriate information to assist us with assisting you. So that we may spend the time we have scheduled wisely and adequately to address your needs , please have these forms completed prior to your appointment. If you should have any questions, please contact us. Thank you.
Hypnotic Therapeutics - New Client Intake Form
Hypnotic Therapeutics - Life History Questionnnaire
Hypnotic Therapeutics - Disclosure of Services
Hypnotic Therapeutics - Acknowledgement of Services and Fees
Hypnotic Therapeutics - Request For Medical Referral Form
For minors, (children under 18 years of age), please have the following forms completed by their legal guardian(s):
Hypnotic Therapeutics - Parental Consent Form
Hypnotic Therapeutics - Consent To Release Information
Please Note:
**You must bring the forms with you at the time of your initial consultation.
***Consent to Release Information and Parental or Custodial Consent forms only need be completed for minor children.
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