Client Intake Form

{Large Group sessions would consist of 4+ individuals for the same topic / Employee Group sessions are 10+ individuals for business employees for same topic}

Describe Other:

Describe Other:

Due to the natural ability of the mind, any final outcome is based upon your own willingness and commitment to follow through with suggestions provided, combined with unknown various possible outside influences. Therefore, although I do and will pull out every option possible within the techniques at my disposal, to provide you with complete success, there is no possible way to guarantee any service provided will be successful. By purchasing or participating in any service provided, you are accepting full and complete responsibility with the information included herein, in regard to your rate of success, or lack there-of. Additionally, you fully agree to and understand that Eva Wells / Sue Ulm / 1st Choice Hypnosis is in no way liable for any loss, accident, injury, or complication, regardless of cause or situation.

I understand that any program that I purchase and begin is valid and must be completed within 90 calendar days from the original date of purchase unless otherwise previously agreed upon. Any unused appointments after that date will become null and void, unless otherwise previously agreed upon and put in writing by Eva Wells or Sue Ulm / 1st Choice Hypnosis.

Hypnosis techniques are not in any way meant as a substitute for standard medical, psychiatric, or psychological treatment. All content on this website, or in any other format, is for informational purposes only. It is not intended to diagnose, treat, or act as a substitute for professional medical advice. Any changes to your current treatment should always be monitored by your physician. I also further note, I am not a licensed medical/mental facilitator. If you under a physicians care or guidance, a written statement from that care-giver must be provided stating acknowledgment of my involvement in working with you, through hypnosis, and this statement will be retained in your file, along with contact information for that provider. Falsifying such information of failure to provide the proper forms may result in refusal of any and all sessions, with no refund of any fees paid. Additionally, if you are receiving any audio recording, you agree to not listen to that unless you are in a safe place, and not in a vehicle or while operating machinery of any kind.

It is important to keep your appointments and to arrive on time; regardless of if your appointment is via online, phone, or in-office. While I understand that things do happen at times, However, I do require a MINIMUM OF 4 HOURS NOTICE if you need to reschedule. When this notice is not given - you will forfeit that session or will be charged the full session price. This policy is strictly enforced and this is the only notification you will receive of such. Thank you. E.Wells, CPHi, CMCL @ 1st Choice Hypnosis 937-315-2730 (text or call) eva@1stchoicehypnosis.com // Misty Sue Ulm, CPH @ 1st Choice Hypnosis 937-489-4107 (text or call) sue@1stchoicehypnosis.com