Application Form for Children, Virginia Beach Hypnosis

I am aware of the cost of the service I am seeking. (Fees Page)

Cost of Service *

$540$940$340 (1 session for Regression Only)

Method of Payment *VenmoCash AppCash

Date of Application *

How did you find me? *0 / 50

Child's First Name *Indicate what you would like me to call the child

Child's Last Name *

Child's Date of Birth *Enter your DOB as month/day/year

Child's Gender *MaleFemale

Street Address *

City *

State/Province *

ZIP / Postal Code *

Phone *

Email Address *

Child's Education *

Child's Academic Performance *A StudentB StudentC Student

Names of Parents *

Parents Occupation *

Are the Parents together? *YesNo

Does the child have any Siblings? *Names and Ages

Who is the child's best friend? *

Does the child have any imaginary friends? *if yes, what is His/Her Name?

Child's Beliefs *Does the child believe in Angels, Magic and Santa Claus?

Does the child have any Pets? *Name and type of Pet

Name of the child's Favorite TV Character *

What is the child's favorite story *

What activities makes the child happy? *

Preferred time of session *

Describe the current issue *

What year did it start and did anything happen in your life when this problem started?

Terms and Conditions

Virginia Beach Hypnosis Terms and Conditions

Hypnosis is not intended to replace medical or psychological treatments offered by any Doctor.

I understand that there are no refunds. The fee remains the same regardless of the number of sessions used. I also understand that I MAY need extra sessions for an extra fee.

The number of sessions required depends on the depth and nature of the issue. Alcohol, drug, gambling addictions, weight loss, and trichotillomania may need 9 to 12 sessions.

I am responsible for my own success by completing all the required sessions and accepting the suggestions.

I understand that Hypnotherapy may not work for everybody and the amount of success is variable between people.

If hypnosis does not work for me, I agree not to leave any kind of negative review including but not limited to text, rating, verbal or online. In addition I agree not to disseminate anything negative about Megan or VBH.

Considering any issues that may arise, I agree to contact Megan personally to arbitrate.

The sessions will be audio recorded to protect the client and the hypnotherapist.

If I breach this contract, I agree that this contract can be used in a court of law. Should litigation become necessary, I agree to be responsible for any court costs, including but not limited to compensation for any litigation time spent, loss of income, attorney fees and other related expenses during this process.

Please Upload a Current Photo of the Child *

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Cost of Service *

Preferred days for sessions *

Virginia Beach Hypnosis Terms and Conditions