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Medical Mental & Emotional Health History

Are you currently receiving treatment for any mental health conditions (e.g., anxiety, depression, PTSD, bipolar disorder, schizophrenia)?
Are you currently taking any medications that affect mood or consciousness?
Have you ever experienced severe emotional distress, trauma, or dissociation?
Do you have any concerns about being in a deeply relaxed, hypnotic state?

Understanding the Nature & Risks of Past-Life Regression Hypnosis:

Past-life regression hypnosis is a guided process that facilitates deep relaxation and recall of subconscious memories. It is intended for personal insight, exploration, and spiritual development. However, it is important to understand the following:

  • Emotional Triggers: Regression may bring up intense emotions, memories, or sensations related to past experiences (real or symbolic). These may be pleasant, neutral, or distressing.

  • Post-Session Integration: Some individuals experience lingering emotions or insights requiring further reflection, support, or healing work. It is your responsibility to ensure you have adequate emotional support (e.g., therapist, counselor, trusted friend) if needed.

  • No Guarantee of Results: Each session is unique, and experiences vary widely. Some individuals recall vivid past-life memories, while others experience abstract symbols, emotions, or nothing at all.

  • Not a Substitute for Therapy: Hypnosis is not a replacement for medical or psychological treatment. If you are experiencing significant distress or unresolved trauma, please consult a licensed mental health professional.

Payment Policy: The invoice for the session will be sent to you upon booking your session and must be paid in full at least 24 hours prior to the scheduled appointment. Failure to make payment by this deadline will result in automatic cancellation of the session.

Liability Waiver & Consent:

I understand that past-life regression hypnosis is a form of guided meditation and self-exploration, not a medical or psychological treatment. I acknowledge and accept the potential emotional and psychological risks involved. I understand that I am responsible for my own well-being and integration process following the session. I release the practitioner from any liability regarding my experience and its outcomes.


I confirm that I am of sound mind and body and freely choose to participate in this session. I have disclosed any relevant health conditions and understand that I may stop the session at any time if I feel uncomfortable.

Date:

Post-Session Recommendations:

  • Take time to journal, rest, and process your experience.

  • Seek additional support (therapist, counselor, energy worker) if intense emotions arise.

  • Drink water and practice grounding techniques (e.g., walking in nature, mindfulness).


Thank you for your trusting me to support you in this process. May this session bring you the insights and healing you seek.

Hypnosis Intake & Liability

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