Application Form for Adults, Virginia Beach Hypnosis

IMPORTANT, PLEASE READ:

Fill out the form only if you are ready to make the payment and proceed with the sessions.

No walk-ins. Clients accepted by appointment only.

Full payment is required at least 24 hours before the session. If you cancel your appointment no less than 12 hours, the money will be fully refunded. However, after using the first session, whether you use the remaining sessions or not, the fee remains the same and there will be NO refunds. The fee is per program, not per session. Missed appointments without proper prior notice will count as used sessions.

The information you provide is strictly confidential. You get the same confidentially at Virginia Beach Hypnosis as you would get at your doctor’s office. Please answer all the questions with honesty. No need to be shy or embarrassed. I can help you better if I know all the facts upfront.

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 the 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?

Marital Status *Are you Married or in a Relationship and is it a happy one?

Employer *

Profession/ Title or Rank *

Level of Education *

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

What is your Favorite Color? *

Favored Vacation Spot *Select favored vacation type or location

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

Names of Children *Enter Names, Gender and Age of Children if any

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.

Please Upload a Current Photo of Yourself *

No file chosen

Virginia Beach Hypnosis

Virginia Beach Hypnosis, 99% success rate, Top Rated, Best Hypnotherapist Award Winner two years in a row (757) 577-2002

Cost of Service *

Preferred days for sessions *

Virginia Beach Hypnosis Terms and Conditions