Past Life Regression Sessions - CONFIDENTIAL CLIENT INTAKE FORM

FEES & PAYMENT: Payment is due in full prior to your appointment via the online link.

CANCELLATION POLICY: Your time slot is reserved exclusively for you. Please arrive promptly to obtain your full session. A 7 day cancellation notice is required, except in an emergency. If you must cancel or reschedule due to an emergency, please notify us as soon as possible. In the event that you do not arrive for your session and proper prior notice has not been made, you will be charged the entire fee for the session. Thank you for your consideration. All prepaid sessions are non-transferrable.

CONFIDENTIALITY: We will not release any client information to anyone without a written authorisation from you, except as provided for by law.

SAFETY: Sessions may be video recorded for client and practitioner safety. These recordings are kept confidential and are securely filed. Recordings are not made available to clients. Clients my audio record their sessions on their own devices. I understand Hypnotherapy (including Past Life Regression and Soul Regression Therapy) is not a replacement for medical treatment, psychological or psychiatric services or counselling and I also understand that the Hypnotherapist does not treat, prescribe for or diagnose any condition.

RELEASE STATEMENT: I give my full consent to receiving sessions by Tania A. Davies for the purposes outlined in this intake form and for future purposes that I may request. I understand that the success of my sessions depends greatly on my own ability and desire to affect change in myself. I understand that the results of my session(s) depend greatly upon my own serious participation and that Tania Davies and Mindful Impact™ cannot offer any guarantee of the success of my treatment. I am aware, however, that Tania Davies and Mindful Impact™ will do everything in their power to ensure my success and I agreed to participate in each session to the best of my ability. I hereby release Tania Davies and Mindful Impact™ from any liability. I also understand that I have other choices from which to seek assistance regarding my specific concerns, and I have chosen Past Life Regression/Soul Regression/Hypnosis at this time. I have been advised that I am free to terminate any or all sessions at any time. I have accurately provided background information as requested by Tania A. Davies. I understand that, during the session/s, the practitioner may touch me as part of the necessary techniques. The practitioner will always advise of the location of described touch and I hereby give my permission for such touch to take place only when/if necessary.