Quantum Regression Agreement Form

Name *

Email *

I have been hypnotized before *

Yes
No
Unsuccessfully (please clarify below)

My main reasons for wanting Quantum Regression are... *

NOTE: Provide general comments at the very least but any information will be useful in preparing for the session appropriately.

I am of legal age and voluntarily wish to participate in this Quantum Regression session. I am willing to be guided through relaxation, visual imagery and regression. I understand this modality is not a substitute for regular medical care and cannot be used to diagnose or treat any type of physical or mental disorder nor is hypnosis a substitute for regular medical care. *

Agree

I understand that I am not a patient, but a co-creator in my Quantum Regression experience. I understand that change is my own and complete responsibility and that ALL HEALING IS SELF HEALING. I understand that any subsequent self-healing involves self-care physically, mentally, emotionally and spiritually which may take time. I understand I may be assigned “homework” or be asked to make changes to my life by my "Higher Self" to complete or solidify any healing or changes begun in the session today. I understand that this information and advice for change comes not from the facilitator, but from my own higher being. *

Agree

I understand that all information I give for the purpose of the session will be held as strictly confidential and that any misleading information I provide or information that is purposely omitted may skew the session. It is my responsibility to be open and honest, provide accurate feedback, and be forthcoming with details and information that may help me achieve my outcomes. *

Agree

I understand that in these types of metaphysical sessions, the energy in the room can affect the equipment and recording resulting in static or blank recordings. (This is quite rare, but it does happen) I understand that I will be given a copy of my recorded session and it is my responsibility to save and store my session safely. I understand that sessions performed over the web have inherent technical issues that may result in interruptions or disconnections that may or may not be able to be resolved. *

Agree

I understand that my name and personal information will be kept completely confidential and I may share my recording and information in the future in any way that I am personally comfortable. I understand that often in intuitive or Quantum Regression sessions, universal information is provided through the client to benefit all of humanity. I agree to allow Soul Healing Essentials to share this information and any accompanying story summary either on video or in written form in blogs or books as long as my name and all personal/relevant details are omitted or changed to protect my identity. *

Agree

I understand that Soul Healing Essentials may elect NOT to proceed with the session if it seems it is not in either party's best interest to do so. Soul Healing Essentials takes NO FEE for a declined session and is NOT liable for travel costs (airline, hotel, etc.) associated with declined session. *

Agree

I agree and understand that this item is non-refundable once purchased. *

Agree

Additional information

NOTE: Provide any additional information you may feel is relevant to the booking of this session including any/all prescription medications used for anxiety, depression, seizures or pain. Please advise if you have ever been treated for schizophrenia, MPD, psychosis or PTSD.