Client Information and Agreement Form
(click here to download)
I fully understand that Maggie Kozlowski is not a doctor nor has a degree in Psychiatry, and can neither diagnose nor treat any type of physical or mental disorder.
I am participating in hypnosis by my own choice because I want to be here.
I understand that any suggestion that is made during the hypnosis session is only part of a personal and educational motivation program, and is only informative.
I understand that my progress involves how I care for myself physically, mentally, emotionally and spiritually.
I understand that the hypnosis session is exclusively for educational and emotional reasons. It is not intended to be in any way, used as medical or psychological advice. This can only be given by a medical professional or a mental specialist.
I understand that transformation is a process and that it can take time.
I understand that Hypnosis is not intended to cure any specific condition. I make absolutely no claims of a cure for any disease. Individual results may vary. Each person is unique and its success depends on your cooperation and faith in the process.
I understand that Maggie Kozlowski is not a QHHT practitioner even though she went through the QHHT training and provided sessions to 25 clients. However, some of those sessions were provided on line via Skype and Zoom and not in person. Quantum Healing Hypnosis Academy has a strict policy that QHHT is to be done “in person” only, as a safety precaution due to the deep level of trance.
I understand that by signing this document I agree to the potential of technical difficulties that may occur with the understanding that we will reconnect as soon as possible to bring you out of the trance in a safe and proper way.
I am willing to be guided through relaxation, visual imagery, hypnosis, and/or stress reduction techniques. I am aware that these modalities are spiritual-based and non-medical in nature and it is my responsibility to consult my regular doctor about any changes in my condition or changes in my medication.
I understand the above modalities are not substitutes for regular medical care and I have been advised to consult my regular medical doctor or health-care practitioner for treatment of any old, new or existing medical conditions.
I understand that being hypnotized is not being asleep. During a deep hypnotic trance, you can open your eyes, speak, laugh, walk and you may be aware of everything that happens around you. You can even open your eyes and think it is not working and are not hypnotized. But when you allow those feelings or thoughts that come to your mind to flow freely as Maggie speaks to you, you will relax and remember forgotten events in this life or a past life.
I understand that change is my own and complete responsibility. I understand all healing is self-healing and that Maggie Kozlowski is only a facilitator in the process of helping me to solve my own problem(s). 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.
I understand that our session will be digitally recorded for my later use and that and Maggie Kozlowski retains the copyright of these recordings. I also 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.
I understand that often in Hypnosis sessions, universal information is provided through the client to benefit all of humanity. I agree to allow Maggie Kozlowski to share this information and any accompanying story either on video or in written form in blogs or books as long as my first and/or last name and personal and relevant details are omitted and/or changed. (On YouTube videos, you will agree on what to omit.)
I understand that if I make travel arrangements to see Maggie, I will not hold Alba Weinman responsible for any costs incurred, such as travel or hotel, in the event that the session is cancelled. We strongly suggest you protect yourself with Travel Insurance. In the event of a disaster (natural or man-made), emergency, accident or illness, sessions can be cancelled on short notice. Maggie will not conduct a session if she is ill.
I am of legal age and understand that I am entering into a cooperative relationship of my own free will. I accept that I am a willing participant in this cooperative relationship that will employ hypnotic techniques,regression, NLP and any other appropriate modality by Maggie Kozlowski. Therefore, I do hereby release and discharge Maggie Kozlowski from all claims of damages, copyright, demands or actions whatsoever in any manner arising from or growing out of my cooperative participation. Any concerns or questions can be addressed by the International Association of Interpersonal Hypnotherapy as the governing and credentialing body. I have received and read this Client Information and Agreement Form and understand what I have read.
Client Name _______________________ Client Signature _______________________
I hold the level 1 QHHT Practitioner certificate, founded by Dolores Cannon. I commit to you that I will utilize all of my skills and gifts to help you. You have my assurance of my full integrity, professionalism, confidentiality and respect.
All sales are final and no refunds will be given. If your booking falls through you are guaranteed a session and you will have an opportunity to book your session at a more convenient time via email.