Our Minds Are Amazing LLCPlese complete this form (All information is strictly confidential.) Your name Your address Your email Your phone If you have ever been hypnotized before, please explain about it! What do you want to accomplish through the use of hypnosis? I am willing to be guided through relaxation, visual imagery, creative visualization, hypnosis, and stress reduction processes and techniques for the purpose of vocational or avocational self-improvement. I understand that the hypnotherapy I am receiving is not a substitute for normal medical care and I am advised to discuss this hypnotherapy with any doctor who is taking care of me now or in the future. Additionally, I should continue any present medical treatment and consult my regular medical doctor for treatment of any new or old illnesses.