Hypnosis Contact Information
Past life regression information form
Email address *
Name *
Your answer
Email *
Your answer
Address *
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Phone number
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If you are under the care of a doctor or psychologist, do you have their permission for a hypnosis session with an H3 Hypnotist/Hypnotherapist? *
Do you have a medical condition or psychological history that the Hypnotist should be aware of before the hypnosis session? *
Have you ever been hypnotized and/or regressed? *
If yes, briefly describe what for and your experience.
Your answer
If yes, can you describe the induction used (how the hypnotist puts you under)?
Your answer
During the induction we like to have the person visualize/feel a place that makes them feel relaxed, safe and happy (i.e. beach, meadow, clouds, special room). Where would that place be for you?
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What do you want to accomplish with this session? *
Your answer
I received and read the Past Life Regression Expectations document and agree/accept the information found in these sections. *
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Preferred Payment Method *
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