Application Form for Teenagers, 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

First Name *Indicate what you would like me to call you

Last Name *

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

Gender *MaleFemaleNon-binaryOther

Street Address *

City *

State/Province *

ZIP / Postal Code *

Phone *

Email Address *

Have you ever been Hypnotized? *When, Why and what was the outcome?

Level of Education *

Religion *What is your religious belief and do you believe in the Afterlife?

What is your Favorite Color? *

Do you have any Pets? *Name and type of Pet

Name 3 people that are close to you *Name 3 people that are close to you and the relationship

Did you have a happy childhood? *

Can you swim? *YesNo

Are you allergic to Cats? *YesNo

Do you smoke? *YesNo

Do you drink alcohol? *YesNo

Preferred time of session *

Describe the current issue *

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

NOTE:

Weight Loss Clients - Please name the foods that contribute to your weight gain. Do you eat Pasta, bread, pizza, sweets? How much water do you drink a day? Do you exercise and how often?

Smokers - Please mention how long you have been smoking, what you have tried so far to help you quit and why you decided to quit now.

For Addictions - Please explain why you want to get rid of your bad habit NOW?

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.

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Preferred days for sessions *

Virginia Beach Hypnosis Terms and Conditions