Beach Hypnosis (757) 577-2002

Beach Hypnosis…

IMPORTANT, PLEASE READ BEFORE FILLING OUT THE APPLICATION:

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

Please do NOT fill out the application for someone else, not even for your spouse!

Therapies are custom tailored to fit each client’s needs. The answers will be used during the session for a more effective session.

You get the same confidentiality with Beach Hypnosis that you get from your doctor’s office. Your information will NOT be shared, sold, or made public.

The fee is for ONE PROBLEM only and maximum 3 Sessions IF needed. 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 unused sessions CANNOT be sold, transferred, combined or used for other problems.

The full payment is required at the time of the session.

Clients are accepted by appointment only. No walk-ins.

Missed appointments without proper prior notice will count as used sessions.

The first session is about 30 minutes and subsequent sessions are about 20 minutes long.

If you wear hearing aids, please wear them and make sure the batteries are fresh. It’s hard to hypnotize someone while yelling.

Please read the FAQ page on my website. It may answer some of your questions, so we can spend less time on questions and more time on the session.

Make sure to read the “Terms and Conditions” at the bottom of the application before checking the box.

P.S. I don’t accept suicidal clients!

I am aware of the cost of the service I am seeking. (FEES PAGE)

Cost of Service *$550 (ONE Problem Only, Max 3 Sessions IF needed)$250 (1 session for Regression Only)

Date of Application *

How did you find me? *0 / 50

First Name *What name do you go by?

Last Name *

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

Gender *MaleFemaleNon-binaryOther

Street Address *

City *

State/Province *

ZIP / Postal Code *

Phone *

Confirm Phone *

Email Address *

Employer *

Profession/ Title or Rank *

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

Level of Education *

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

What is your Religion? *

Do you beieve in an Afterlife? *YesNo

What is your Favorite Color? *

Favored Vacation Spot *Select favored vacation type or location

Can you swim? *YesNo

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

Did you have a happy childhood? *

Names and Ages of Children/Grandchildren *Name them, but only if they are close to you.

Name other people that are close to you *Please specify (Spouse, Parents, Friends)

Are you allergic to Cats? *YesNo

Are you Claustrophobic? *YesNo

Do you smoke? *YesNo

Do you drink alcohol? *YesNo

Do you suffer from any Attention Disorders, such as ADD and ADHD? *YesNo

Are you Suicidal? *YesNoIncludes suicidal thoughts, tendencies or actual attempts.

You have identified as suicidal...

Sorry {name-1-first-name}, I do not accept Suicidal Clients.

Please seek Professional Help

Are you ready to start your sessions? *YesNo

Explain *Indicate reasons you are not ready yet, and expected time frame when you will be...

Preferred time of session *

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?

Cigarette or e-Cigarette Smokers/Vapers/Tobacco Chewers - Please mention how long you have had this addiction and which one.

Describe the Problem (The fee is FOR ONE PROBLEM ONLY and covers up to 3 sessions.) *

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

Other Reason/Motivation *Please enter details above

Terms and Conditions

Beach Hypnosis Terms and Conditions

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

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

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

The number of sessions required depends on the depth and nature of the problem. Alcohol, drugs, gambling addictions, weight loss, trichotillomania and other severe cases may need 9 to 12 sessions, for additional fees.

The unused sessions CANNOT be sold, transferred, combined or used for other problems.

Missed appointments, or cancellations without a minimum of 24 hours notice will count as used sessions.

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

Considering any issues that may arise, I agree to contact Megan personally to arbitrate. If hypnosis therapy doesn’t work for me or if I have any disagreements, I agree to resolve it with Megan first before I file any complaints, including but not limited to the Better Business Bureau, the city or any other institution.

If hypnosis does not work for me, I agree not to leave any kind of negative reviews including but not limited to texts, ratings, verbal or online posts. I also agree not to disseminate or instigate anything negative about Megan or Beach Hypnosis.

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.

Beach Hypnosis reserves the right to refuse service to anyone.

Beach Hypnosis does not discriminate based on Race, Color, National Origin, Sex or Religion.

Consent to Terms and Conditions *I read, understood and agree to the terms and conditions listed above.

Please Upload a Current Photo of Yourself *

No file chosen