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

Parent Consent Form For Child Client
Required for all new minor clients

Parents of Child Clients - prior to or before our consultation or first session, please complete and submit the Adult Intake Form with your information.  Then, please complete and submit this form with your child's information.

PRINT/DOWNLOAD VERSION CONSENT FORM FOR MINORS

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.