Master Hypnostist

 

Doctor Treatment Permission

Hypnosis Intake Form

Each client must also send a scan of handwriting sample 24 hours prior to session. Please do two paragraphs of at least three sentences each about the reason for the session in their typical handwriting on unlined paper signed and dated.
 
A picture will suffice but should indicate boundaries of paper - scale is importan
t

Please fill in the forms attach the handwriting sample and send them all : Robert Bureker
202 W. Coral Gables Dr.
Phoenix, AZ 85023

You may use this contact link for a reply by email.