We’re excited to have you join us!Please fill out this Workshop Registration form so we can get to know you. Name * First Name Last Name Date of Birth Email * Do you have a nickname you prefer? Please write it below. If not, just skip this step. Phone * (###) ### #### Texting permission Can we text you a reminder to attend the Workshop on March 31? Yes - text me No - please email instead Preferred method of contact: * Phone Email Emergency contact: In the event of an emergency, whom should we call? * Please list name and phone number How did you learn about Anderson Hypnosis Center? * What do you hope to learn or experience in this workshop? * What is your profession, and do you wish to learn more about how hypnosis skills can help you in your work? * Do you have any fears about hypnosis? * Yes, I'm nervous Not at all I'm not afraid, but I do have some questions. Please review our client agreement here before your appointment. We can discuss and sign it in person at your first appointment. * CLIENT AGREEMENT I understand that Wally Post is a Certified Consulting Hypnotist and unconscious coach, and not a medical doctor or psychologist; that he cannot diagnose disease, prescribe, medicines, or treat medical conditions or disorders. I also understand that the coaching and training I am receiving from Wally Post is not a substitute for medical care. I have also been advised to discuss this process with any doctor who is currently treating me or now or will treat me in the future. Additionally, I should continue any treatment of any new, current or past illnesses. I am willing to be guided through various methods, including relaxation, visual imagery, creative visualization, hypnosis, neurolinguistic programming (NLP), Emotional Freedom Techniques (EFT), Graph Analysis and Stress Reduction processes for the purpose of vocational or avocational self-improvement. I also agree that Wally Post, or myself may terminate this relationship at any time and for any reason whatsoever. I realize that although Wally Post has considerable training and a decade of experience, the training and insight he provides are not a cure. I accept that I am paying for his time, expertise, and insights, irrespective of any particular result. I’m responsible for payment of my appointments unless they are cancelled the day before. Not responding to the confirmation text is not a form of cancellation. All clients under the age of 18 will need the consent of an adult who can be present at their appointment. Agree Thank you! We will be in touch and look forward to seeing you soon! NEW CLIENT? VIEW OUR HELPFUL INTRO VIDEOS:
