Nontakorn Hypnotherapy
Certified Medical Support Clinical Hypnotherapist (CMS-CHt)
Fellow of the International Board Of Hypnotherapy (FIBH)

Adult Client Intake Form
Required For All New Adult Hypnotherapy Clients

Adults - Please complete and submit this form with your information prior to your consultation or first session.

Parents of Child Clients - Please complete and submit this form with your information prior to our consultation or your child's first session.  Please do not put your child's information on this form.  Please use the Parent Consent Form for information pertaining to your child

 

PRINT/DOWNLOAD VERSION ADULT INTAKE FORM

Hypnotherapy Academy of America

International Board of Hypnotherapy

Hypnotherapy is an educational self-improvement process that facilitates access to internal resources that assist us in solving problems, increasing motivation, or altering behavior patterns to create positive change. Hypnotherapy is NOT a substitute for medical treatment or psychotherapy. Nontakorn Hypnotherapy does not practice medicine or psychotherapy. The services of this company are NOT replacement for counseling, psychotherapy, psychiatric, or medical treatment. No service or product provided is intended to diagnose or treat any disease or illness, psychological, or mental health condition. Medical Support Hypnotherapy is used ONLY as an adjunct to conventional medical treatment. Consultation with a licensed physician is required before medical support hypnotherapy services can be provided.