Nashville Hypnosis ::: New Client Information

The short form below will register you as a new client and confirm your appointment (If you do not have an appointment please call 615-430-4735). When you click 'Submit', you will be taken to a new page that contains the 'Intake Form' downloads. Please download, fill out and bring the appropriate form to your first appointment.

You may pay with cash, check, debit card or major credit card. Full payment is required prior to first session, unless otherwise agreed upon. Payment may be made at my office or, you have the option of paying, on the next page, with a credit card or PayPal.

For pricing and appointment info click here.

My office is located at 5054 Thoroughbred Ln, Brentwood, TN 37027(click here for map). I am located inside Health Sphere Wellness Center.

Please arrive a few minutes early so we can spend the most amount of time together and you can receive the maximum benefit. Out of respect of others, your appointment time is for the allotted time discussed, tardiness results in a shorter session for you. This time has been set aside especially for you.

Please Fill Out ALL Fields Below. Please note that your appointment is not confirmed until the form below is completed. All new clients are added to the Nashville Hypnosis Newsletter, unless you specify in the 'Reason' box below that you do not wish to be on the list.

First Name:	Last Name:
Address:	City:
State:	Zip:
Email:	Phone:
Appointment Date:	Appointment Time:
Reason for Hypnotherapy:

You Must Agree to the Following Terms and Conditions

Cancellations must be made at least eight business hours prior to appointment time.
Cancellations, or rescheduled appointments, made with less than eight business hours notice, will be billed as an appointment, or count as an appointment in your package.
Tardiness of more than 15 minutes results in cancellation of appointment, unless otherwise agreed upon.
Missed appointments are subject to a charge of 100 % (at least $90) of session cost, plus $20 office charge, and will be billed accordingly.
Cancellation of packages: Any used sessions will count as full price, plus $30 cancellation fee, you will be refunded the difference.
If you are under the care of a psychiatrist, I require written approval for your therapy.
Please practice good hygiene.
No children unless he/she is a client.
All sessions may be recorded, audio, and/or video, for archival purposes. No recordings will be used for public display unless otherwise agreed upon
I reserve the right to refuse service to anyone.
Have fun.
Learn something new.
Feel something new.
Change your mind.
Smile : ), your life is about to change.

I Agree to the Terms and Conditions*:

Sign Full Name Here

Nashville Hypnosis
(615) 430-4735
5054 Thoroughbred Lane, Brentwood TN 37027