Athlete Intake Form

I understand that good and lasting results may require several hypnosis sessions and that I will be required to practice self-hypnosis and visualization. I am responsible for actively cooperating with, and participating in my program. Jordan Bloom, CPH shall not be held accountable for the results I attain. I understand that like other healing arts, the practice of hypnosis and hypnotism is not an exact science. Therefore, results are not guaranteed, nor are refunds given for services rendered. Sessions at Wise Mind Hypnosis are videotaped, held confidentially and become the property of Wise Mind Hypnosis. I understand all information about me will be kept strictly confidential.