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 Read Before Submitting

A Sound Healer / Shamanic Practitioner is not a doctor and therefore will not diagnose or treat any specific illness.  If you have a medical problem you are advised to seek professional medical help. 

You may experience some discomfort after your treatment. This is caused by your body trying to heal itself. Your symptoms may get worse before they get better. With most people this process generally takes 2-3 days.

In the 2-3 days after your treatment drink plenty of water, take some gentle exercise and take it easy. Give your body a chance to heal itself. If you are still feeling discomfort after 5 days you may wish to contact your practitioner.

I have read and understood the above. I have had sound healing explained to me and I consent to receiving sound healing.

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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