Hypnosis Intake Form

Thank you for choosing Queen of Cups Hypnosis!  

This form is designed to provide your Hypnosis Professional with a more detailed view of why you are seeking hypnosis at this time.  All information should be completed to the best of your ability and answered honestly.  Each question on this form will help your Hypnosis Professional as they guide you through your first session of hypnosis, as well as through future sessions.  

All information is held in the strictest confidence, and will not be shared with anyone else, unless required to do so by law.  Even when we’ve been directed to provide information as required by law, only the information requested will be provided to ensure the confidentiality of your other records.