G88dvibrations Intake Form

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Medical and Emotional History

Which of the following are you currently experiencing/have experienced in the last 90 days as it applies to your physical health? Please check all that apply.
Which of the following are you currently experiencing/have experienced in the last 90 days as it applies to your fears? Please check all that apply.
Which of the following are you currently experiencing/have experienced in the last 90 days as it applies to what you believe ails you? Please check all that apply.
Which of the following would you like to include in your awareness shift? Please check all that apply.

CONFIDENTIALITY AND CLIENT ACKNOWLEDGEMENT

I understand and acknowledge that hypnosis is not and does not replace medical treatment. G88dvibrations LLC practitioners are not medical doctors and, as such, practitioners do not diagnose conditions. Hypnosis and other modalities of healing work well in conjunction with traditional medical treatments. G88dvibrations LLC recommends seeking the advice of a medical doctor before beginning any type of treatment plan. G88dvibrations LLC does not record sessions and keeps client data in the strictest of confidence. We do not disclose any information regarding your sessions, except in cases where we are compelled through a court order or subpoena with which we are bound to comply. If you wish for us to discuss any details of your treatment with a referring physician or other individual, we will require your explicit consent in order to do so out of respect for your privacy.
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