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Cross Conscious Hypnosis
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    • Home
    • About
    • Background
    • Services
    • Schedule
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    • FAQ
    • Forms
    • Donate
Cross Conscious Hypnosis
  • Home
  • About
  • Background
  • Services
  • Schedule
  • Contact
  • FAQ
  • Forms
  • Donate

Downloadable Forms

Bill of Rights & Disclosure of Services (pdf)Download
Client History Form (pdf)Download
Disclaimer (pdf)Download
Insurance Waiver (pdf)Download
Referral Form (pdf)Download
Request for Medical Referral (pdf)Download
Safe & Ethical Practice (pdf)Download
Code of Ethics & Conduct (pdf)Download
Participation & Media Consent Waiver (pdf)Download
Acknowledgment of Sponsorship or Charitable Contribution Receipt (pdf)Download

Filling Out/Returning Forms

  • DocHub is a free and easy to use resource for forms. 
  • All forms must be completed, signed, and dated.
  • Forms may be returned to me in-person, by mail, or email.

Memberships & Affiliations


I am not a doctor and do not diagnose or prescribe. I am a Certified Consulting Hypnotist. I have received formal education and training to assist individuals with making desirable changes to their behaviors, reactions, and performances. I do this by guiding their conscious and subconscious mind to alternative patterns of thinking and emotional processing.


The services I render are held out to the public as nontherapeutic hypnotism, defined as the use of hypnosis to inculcate positive thinking and the capacity for self-hypnosis. I do not represent my services as any form of health care or psychotherapy, and despite research to the contrary, by law I may make no health benefit claims for my services.


Copyright © 2023 Cross Conscious Hypnosis  - All Rights Reserved.

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