INTAKE FORM

ACKNOWLEDGMENT AND CONSENT

I am excited to embark on this Quantum Healing Hypnosis Technique (QHHT) journey with you. Before we dive in, let’s just go over a few important points together to make sure we’re on the same page. Please read through the following and confirm you understand and agree:

  1. The Technique & The Outcome: I understand that Denise Coon will use Dolores Cannon’s Quantum Healing Hypnosis Technique (QHHT) to guide me into a relaxed state of hypnosis. While this process can be incredibly insightful, I understand that there’s no guarantee of any specific outcome – every person’s experience is unique!
  2. Your Comfort & Session Length: I know I’m always in control and have the right to stop the session at any time if I feel the need. I also understand that sessions can be quite comprehensive, and if our time together extends beyond 3 hours, the service fee becomes non-refundable.
  3. Denise’s Role (Not Medical Advice): I understand that Denise Coon facilitates the QHHT hypnosis session. She is not a licensed physician, psychologist, counselor, or therapist. This means she cannot diagnose conditions, prescribe treatments, or provide therapy for any mental or physical health issues. QHHT is a valuable tool, but it is not intended as a replacement for professional medical or psychological diagnosis, advice, or treatment.
  4. Your Healthcare: It remains my responsibility to consult with qualified doctors or healthcare professionals for diagnosis or treatment of any medical or psychological conditions, and regarding any changes in my health or medication.
  5. The Power Within (Self-Healing): I recognize that ultimately, all healing is self-healing. Denise acts as a skilled facilitator to help me connect with my own inner wisdom and resources. To make the most of our session, I understand it’s helpful for me to share openly and accurately, and I’m responsible for how I integrate the experience afterwards, which might include listening to my session recording and following the guidance that resonates from my Subconscious/Higher Self.
  6. Source of Insights: If suggestions for life changes come up during the session, I understand these insights are considered to be coming from my Subconscious/Higher Self, not from Denise personally.
  7. Session Recording: I understand my session will be recorded for my personal use later – it’s a great tool for reflection! Denise Coon retains the copyright for these recordings. On rare occasions, the unique energy in QHHT sessions can affect recording equipment (leading to static or even a blank recording). While every effort is made to capture clear audio, I understand refunds cannot be given if technical glitches affect the recording quality.
  8. Sharing Your Recording: I’m welcome to share my personal recording privately with friends or family if I wish. However, I agree not to post or upload the session recording publicly on YouTube, social media, or any other internet platform.
  9. Sharing Universal Wisdom (Anonymously): Sometimes, information shared in a session has a universal quality that could benefit others. I agree to allow Denise Coon to share such non-personal, universal insights and the related story (perhaps in audio, video, or written form like blogs or books), only if my name and all identifying personal details are completely removed or changed to ensure my privacy is fully protected.
  10. Release of Liability: By proceeding with the session, I release and hold harmless Denise Coon from any and all claims or liability of any nature that might arise from or be connected to my QHHT session.
***Please print, sign, date and bring to your session.


Signature:___________________________________

Date:________________________________________