Sunshine State Hypnosis Intake Form
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Privacy Policy | Terms of Service
Our goal is to provide a thoughtful and effective process designed around your specific goals and circumstances.
Hypnosis is an interactive process. In addition to live, in-person or online sessions, your program may include self-hypnosis training, guided exercises, and supplementary resources designed to help you continue developing and reinforcing the changes created through the process.
Every person and situation is different. Some clients notice meaningful changes early in the process, while others require additional practice, support, or adjustments to the approach.
Personal change is a process.
The purpose of your customized program is to provide the appropriate structure, guidance, and support needed to help you work toward your desired outcome.
Additional sessions or support may be recommended when appropriate for reinforcement, continued development, or addressing additional goals.Text
Hypnosis is a structured, interactive process that uses instruction, focused attention, expectation, and guided experience to help influence patterns of experience and response.
Our practice of hypnosis is voluntary. You remain an active participant throughout the process. No hypnotist should attempt to make you change your habits, behaviors, thoughts, or feelings against your wishes.
The role of the hypnotist is to provide clear instructions, create an effective learning environment, observe your responses, and adapt the process based on what occurs.
Your role is to participate openly, communicate honestly about your experience, and engage with the process to the best of your ability.
Because every person and situation is different, no specific result or timeline can be guaranteed. What Sunshine State Hypnosis can provide is a thoughtful, individualized process using appropriate hypnotic methods, current professional knowledge, and ongoing observation of your responses combined with your feedback.
Personal Investment & Program Terms
Your program fee reflects the customized scope of work, professional preparation, guidance, and resources included in your agreed program.
Programs are designed around the specific goal being addressed and are not based on purchasing individual sessions or blocks of time. The number of sessions, exercises, or resources required may vary depending on the individual and the complexity of the goal.
Your customized process may include hypnosis sessions, self-hypnosis training, guided exercises, educational materials, and digital resources designed to support the development and reinforcement of new patterns.
The initial assessment provides the basis for recommending an appropriate scope of work. Like many professional services, this recommendation is based on the information available at the time and may require adjustment as additional information becomes available through the process.
If additional complexity becomes apparent while working toward the agreed goal, Sunshine State Hypnosis will discuss appropriate next steps with you before expanding the scope of work or adding additional fees.
Additional support may be arranged when appropriate for reinforcement, continued development, or addressing additional goals.
Scheduling and Appointment Policy
Appointments require preparation and reserve dedicated availability. To provide the best possible service to all clients, scheduling policies must be consistently applied.
Appointment changes must be made at least 24 hours before the scheduled appointment time.
Appointments changed with less than 24 hours’ notice or missed appointments may require a $250 rescheduling fee before a replacement appointment can be scheduled.
Late arrivals of 30 minutes or more may be treated as a missed appointment. Late arrival does not extend the scheduled appointment time.
Appointments and program services are non-transferable unless otherwise agreed.
Sunshine State Hypnosis may waive or reduce a scheduling fee in an individual circumstance. Any waiver or reduction applies only to that specific occurrence and does not modify this policy or waive the right to enforce it in the future.
Program Discontinuation and Refunds
You may choose to discontinue participation in your program at any time. Participation in hypnosis is voluntary, and you are not required to continue a process you no longer wish to pursue.
Your program fee is based on the agreed scope of professional work, preparation, and resources provided. Programs are not the purchase of individual sessions, appointments, or hours.
The initial recommendation is based on the information available during the assessment. As with many professional services, additional complexity may become apparent as the work progresses. A decision not to continue does not, by itself, indicate that the original scope was unnecessary or qualify the program for a refund.
If Sunshine State Hypnosis determines that the original scope was not appropriate or that an adjustment is warranted, any modification, credit, or refund will be handled according to the Program Scope and Adjustments policy.
How can we help?
Scope of Hypnosis Services
Sunshine State Hypnosis provides hypnosis services designed to support symptom management and symptom reduction, as well as changes in habits, automatic responses, behavior, performance, and subjective experience.
Hypnosis uses structured instruction, focused attention, expectation, and guided experience to help influence how people experience and respond to situations.
Hypnosis services are not intended to diagnose medical or mental-health conditions, prescribe medication, or replace appropriate care from licensed healthcare professionals. The practitioner does not recommend discontinuing or changing prescribed treatments.
When appropriate, clients are encouraged to continue working with their healthcare providers. If a goal involves a medical condition, psychological concern, or other circumstance requiring additional professional support, coordination or referral may be recommended.
Health Questions
Other Provider information
We value supporting your overall well-being and, when appropriate, coordinating with other professionals involved in your care.
Providing the names and contact information of relevant healthcare providers allows Sunshine State Hypnosis to better understand your circumstances and, with your permission, communicate information that may help support appropriate coordination of services.
This information is optional unless otherwise required for your specific situation. Any communication with another provider requires appropriate authorization before information is shared.
Client Bill of Rights
Receive clear information about the services being provided, the practitioner’s role, credentials, methods, and fees.
Ask questions about the process and receive reasonable explanations before participating.
Understand the expected scope and purpose of the services being provided.
Participate voluntarily and communicate concerns about the process.
Be treated with dignity, respect, and professionalism.
Be free from physical, verbal, sexual, or emotional abuse.
Decline participation in any service or discontinue participation at any time.
Know that personal information will be handled according to the practice’s privacy policies and applicable requirements.
Seek additional care or services from another qualified professional when appropriate.
Raise concerns or complaints without retaliation.
Insurance
Sunshine State Hypnosis does not bill insurance companies directly and does not submit claims on behalf of clients.
Coverage for hypnosis services varies by insurance provider and policy. If you are interested in reimbursement, you are responsible for contacting your insurance company to determine whether any benefits may apply.
Payment arrangements for services are established directly with Sunshine State Hypnosis and are the responsibility of the client.
Some clients may be able to use Health Savings Accounts (HSA) or other personal healthcare spending accounts for eligible expenses. Clients are responsible for confirming eligibility and requirements with their account provider.
How We Work / Our Approach
Sunshine State Hypnosis uses a modern, principles-based approach to hypnosis that focuses on how attention, expectation, learning, and experience influence patterns of response.
Hypnosis is a structured process that uses instruction, focused attention, and guided experience to help clients develop new ways of responding to situations, habits, emotions, behaviors, and perceptions.
The process may include hypnosis, self-hypnosis training, guided exercises, relaxation methods, visualization, educational materials, and other tools designed to support learning and change.
Rather than relying on a fixed script or a one-size-fits-all approach, the process is adapted based on your goals, your responses, and the information discovered throughout the work.
Because change involves learning and reinforcement, progress often depends on both the work completed during sessions and the ways new skills and responses are practiced outside of sessions.
Your Process Is Confidential
Client records and transactions with the practitioner are confidential, and may only be viewed by Sunshine State Hypnosis staff, unless release of these records is authorized in writing by the client, or otherwise provided by law.
"By completing and submitting these forms online and through payment for services, I am agreeing that all the responses are accurate to the best of my knowledge."