Client Forms

Release Form

I hereby authorize Anita Das to help me to hypnotise me for the purposes outlined in this intake form (for spirit release, hypnotherapy, regression), and for future purposes that I may request. I understand that hypnosis is not a medical procedure and that no medical benefits are being offered to me.   I understand that the success of my hypnosis therapy depends on my ability to relax and my desire to create change in myself. I understand that, because the results of hypnosis sessions depend on my own serious participation, Anita Das cannot offer any guarantee of the success of my treatment.  I am aware, however, that she will do everything reasonable in her ability to ensure my success. I understand and provide consent to allow Anita to touch appropriate parts of the body for body therapy as part of a regression session. I understand that this release statement discharges Anita Das from any liability or claim that I may have with respect to any bodily injury, illness or medical treatment that may arise from, or in connection to any in person or online sessions.

Please Note: I can often re-arrange appointments if necessary but if you need to rearrange or cancel with less than 48 hours notice, I will need to charge you for your missed appointment.

By putting my details on this form and clicking submit, I agree to the terms and conditions outlined above.

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