Forms to Fill Out

Information to prepare you for success (Please read these articles before coming to your first appointment)

Forms to fill out and bring to the first appointment (or email us before the first appointment)

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For Clients Coming in with Medical Issues:
A physician's referral is required. You can either obtain a referral from your current physician, or download and fill out the Release of Medical Information Form. Email or fax the form back (Fax: 240.453.6208). We'll then contact your physician to get the referral.

Recommended Readings For Clients with Chronic Illnesses

The Mindbody Prescription: Healing the Mind, Healing the Pain by John E. Sarno, MD
Answer Cancer (required reading for cancer client. Click on the link to order the E-book)
The connection between mind and skin dis-ease

For Fertility Clients
Additional Form: Fertility Intake Form

For Weight Loss Clients
Additional Form: Weight Loss Questionaire

For Stop Smoking Clients
Additional Form: Stop Smoking Questionaire

Call or Email Family Hypnosis

(30 min. free phone consultation)
240-328-8169
emily@family-hypnosis.com

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Serving Rockville, Bethesda, Potomac, Gaithersburg, Germantown, McLean, Silver Spring, Olney, and all of Montgomery County with the very best in hypnosis services.
In Maryland, Virginia and DC more and more people are pleased and surprised with the results they get from their hypnotist when using hypnotism and hypnotherapy.