Documents & Downloads
- Medical Referral form
- This is a referral form that your medical or mental healthcare professional can use to let us know hypnotherapy will not interfere with your ongoing treatment - or that your complaint has been reviewed medically. Under the following circumstances, we will require this form to be completed by your primary care provider before we can work with you: If you're under the care of a physician or psychologist for the symptom you plan to ask us about. If you're on any kind of medication for any psychiatric diagnosis whatsoever. If you are experiencing physical pain for which you have not yet seen a physician If you're experiencing hallucinations, or urges to harm yourself or others. If, for any other reason, we determine that medical or mental-health screening would be appropriate prior to hypnotherapy.
- One-Way Records Release
- This form authorizes us to release your records to a third party, but doesn't authorize them to release information back to us. This is the form you'd use when asking us to release records to an insurance company to which you were making a claim, etc.
- Two-Way Records Release
- This form authorizes us to release your records to a third party, AND it also authorizes them to release information back to us. This is the form you'd use when asking us to release records to another care provider WHEN it is intended for us to coordinate our work on your behalf with theirs.