Meaghan O'Leary healing & intuitive arts | past life regression intake

What outcome(s) are you wanting to achieve with this work?

First names, ages, and relationship of anyone living with you

Final question! *

I have completed this client intake form to the best of my ability and I have disclosed any mental or physical health problems that may be pertinent to the safe facilitation of a hypnosis session.

Please list any relevant medical conditions, history, or medications that could impact your session.

In the event material is published, including case studies, Meaghan O’Leary PhD RHt has permission to use information from my session in such publication, providing the names and information are altered sufficiently to provide significant anonymity. *

I agree

I do not agree

phone (206) 293-4592 | email meaghan@meaghanoleary.com | office 1417 NW 54th Street, Suite 400, Seattle WA 98107

Thank you! Your input is appreciated and will assist me in preparing for your session. If you have any questions, please feel free to let me know. I am looking forward to our next steps together on your healing journey!

Please share your intention or reasons for having a regression session.

Have you had previous hypnotherapy sessions? (for regression work or any other reason)

'Notice To Clients' Document (this is the document you received from me via email pdf attachment): *

I have received and read the 'Notice to Counseling or Hypnotherapy Clients' information and I understand the contents and implications.

What specific issues would you like to address in this or any future sessions?

Sections marked with a red asterisk are required; the rest are optional (although encouraged). All input is private.

Emergency contact person *

Conditions *

I understand that my hypnotherapist is not qualified to give legal, financial, or medical advice. I agree that I am solely responsible for any action that I take or refrain from taking in connection with the topics discussed during our session.

Establishing and maintaining trust is an important aspect of the hypnotherapy partnership (client and therapist). This allows the conscious mind and physical body to feel secure and relaxed during a session so that the healing messages can be communicated clearly from the subconscious mind.

Gender pronoun preferences

Copyrighted material *

I understand that the copying, dissemination, or presentation of audio recordings or written material provided to me by Meaghan O’Leary PhD RHt is prohibited due to copyright law.

Meaghan O'Leary PhD

healing & intuitive arts

Thank you! Your input is appreciated and will assist me in preparing for your session. If you have any questions, please feel free to let me know. I am looking forward to our next steps together on your healing journey!

Sections marked with a red asterisk are required; the rest are optional (although encouraged). All input is private.

PAST LIFE REGRESSION INTAKE FORM