QHHT Consent form

QHHT consent form

* Indicates required field

Name *

First

Last

Year of birth *

Phone Number *

Email *

Address *

Line 1

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City

State

Zip Code

Country

1. I understand the service being offered is intended for my own self-healing and self-exploration through deep relaxation *

2. I understand that I am not receiving a service from a licensed psychologist or hypnotherapist, and do not intend to receive diagnosis, treatment or cure for any physical or mental illness or disease *

3. I have been informed about what to expect regarding the service I will be receiving and do not hold Cosmic Light or the QHHT practitioner responsible for any unexpected or unanticipated emotions experienced during or after the session. *

4. I understand the location of the service will be in Plymouth, Minnesota, and I will need my own transportation to my session. I understand the session will take 4-5 hours and I will be available for the entire session. *

5. QHHT can help bring clarity and healing to those with mental and physical ailments. However, I am unable to assist those who have been diagnosed with schizophrenia for reasons associated with the clinical diagnosis *

Client Signature *

Today's date *

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Quantum Healing Hypnosis Technique®

CONSENT FORM

QHHT consent form