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Forms

If you are a new hypnotherapy client, please complete the following forms and bring them to your first session.

If the reason for your use of hypnotherapy services involves a medical or psychiatric diagnosis, you may be asked to obtain a signed referral by your primary care or mental health provider in order to provide integrated and collaborative care:

Use this form for medical referrals if you live in California:

Use this form for medical referrals if you live in outside of California:

Use this form for all therapist referrals:

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, or psychotherapist), please complete the following form to authorize the release of your confidential information:

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