Client Participation Agreement

 

Name:__________________________________________________________________

 

Mobile Phone:___________________________________

 

Email:_____________________________________________

 

Age:___________

 

Occupation:______________________________________________________

 

Referred by: ______________________________Internet______  Other__________

 

Prior Experience with Hypnosis / Meditation?______________________________________

 

Motivation for change – 1 very low -10 very high:______Stress Level 1-10­­­­­­­­________

Medical Conditions:_______________________________________________________________

 

________________________________________________________________________

 

Do You Have Pain?  - 1 – 10 - Where? _________________________________________________________________________

 

_________________________________________________________________________

 

Are you under a Physicians Care for any of the above?____________________

 

Sleeping quality (excellent, poor, etc)____________________________________________________________

 

 

What issue(s) would you most like to change or improve?

 

_________________________________________________________________________

 

Any Fears or Phobias?

 

_________________________________________________________________________

 

 

Life Goals _________________________________________________________________________

 

The negative symptoms you’re experiencing have likely been years in the making.  Immediate, positive changes do happen but aren’t the norm.  Overwhelmingly the clients who have the most profound changes are the clients who are the most committed to change and stick with it.

 

Like physical training, mental training takes effort and discipline. The more you put into this work, the more benefits you can expect to receive.

 

We will use the tools of coaching, hypnosis, your inner-guidance and NLP. I will provide self-hypnosis and affirmation tracks for you to use at home to accelerate your change.

 

I will respect your privacy and your name won’t be connected to any sensitive details of your sessions.

 

In our work, we may be healing old, emotional wounds.  When this happens there can be an emotional detoxification as old energy is released from your body.  In other words, things can sometimes feel worse before they feel much, much better.

 

Please initial here: ­­­­­­­­­___________________

PRICING OPTIONS:      (choose one after 1st session)

 

Hourly: $100/hr.  OR Discounted Packages ---

 

Basic: $525  This basic package includes 6 session hours.  It also includes 2 of our self-hypnosis audio mp3 tracks to maximize the effectiveness of your sessions while you listen at home. For some, especially with less complex issues this short-term approach may be sufficient to provide resolution.  Discounted total of $75.

 

Committed: $990 For most, this will be the best choice: 12 session hours and includes 4 of our self-hypnosis audio mp3 tracks to maximize the effectiveness of your sessions while you listen at home.  Also includes 1 bio-mat session within the 12 hour total time. Discounted total of $210. 

Fully Committed: $1,920 In-Depth approach includes 24 session hours, 6 of our self-hypnosis audio mp3 tracks to maximize the effectiveness of your sessions while you listen at home and 2 bio-mat sessions within the 24 hour session time.  Email and Text Support are included.  This is the most effective approach and the most economical.  Discounted total of $480.

Sessions are usually 1-2 hours in length.  Packages:  Unused hours expire one year after purchase. Pro-rata refunds are based on $100/hr. are not available 45 days after purchase.

 

Work done with Peter McLaughlin is for self-improvement purposes only and not to be construed as a medical cure for any condition or as a substitute for standard medical or psychological care by licensed medical or psychological personnel.

 

I am of legal age and I hereby release and discharge Peter McLaughlin and BlueSky Works LLC - DBA BlueSky Hypnosis from any claims, damages or any other actions resulting from my sessions with same.

 

 

Signed:___________________________________________           

 

Date:_________________________

BlueSky Hypnosis - 359 Quaker Road, East Aurora, NY 14052  716.628.9833

© 2017, 2018, 2019 by Peter McLaughlin.

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