New Hypnotherapy Client Intake

Estimated time to complete : 1-3 minutes

Congratulations in taking steps towards a healthier existence, and towards getting the support you need. Moving towards improvement begins with us getting to know your needs and your wants. The better we understand you, the better we can help you.


Thanks for selecting me as your Hypnotherapist. I hope you have enjoyed reading my background and getting a feel for who I am and my focus. I look forward to meeting with you, learning more about your path, and working towards your goals.

In order to set you up with your first appointment, I need to gather some information. Please take a few moments to fill in your details below and then click the continue button.

In Washington state, children over the age of 13 are legally allowed to engage in their own self-directed mental health treatment without parental consent. (See Chapter 71.34 RCW) However, we fully encourage the participation of parents in their child's care.
Note: The nature of email communication means confidentiality can not be guaranteed.


You MUST click the continue button below to proceed.