The key to your success lies in the thoughts you can’t hear!

The subconscious mind is the master of our lives, even though we can’t see or hear it most of the time.


The thought patterns laid out in the subconscious were put there years ago, when you were younger, usually through times of massive emotions or pains.


Using Clinical Hypnotherapy, we can rewrite your negative belief systems and improve your mental health, well-being, and personal success.

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 Forms 

DISCLAIMER

The terms Hypnotist and Hypnotherapist are used interchangeably is the following document.


1.    Shira Raymond TPH (Transpersonal Hypnotherapist) has advised me to the scope of hypnosis/hypnotherapy practice and I give consent to receive sessions today and in the future form Shira Raymond.2.    I understand that and result may vary and Shira Raymond does not guarantee results.
3.    I understand that hypnosis/hypnotherapy is not a replacement for medical treatment. Psychiatric, psychological or counseling services. I also understand that Shira Raymond TPH does not treat, prescribe for or diagnose any condition.4.    I understand that Hypnotist/Hypnotherapist that are not practicing any other profession are required a license under the law in Arizona.
5.    I agree to participate in all sessions to the best of my ability. I understand that I am free to cancel or terminate any or all sessions remaining.
6.    I understand that I might be referred out to other mental health professionals if my situation is outside of the scope of Shira Raymond’s expertise.7.    I understand that Shira Raymond TPH will honor HIPPA laws even though she is not governed by those laws.
8.    I give permission for the hypnotist to gently touch me on the shoulder, arm, hands, wrists, legs, face or forehead to help me to further relax. This will only be done for maximum state of hypnosis.9.    I agree to pay Shira Raymond DBA Synergy Wellness Center prior to each session unless other payment arrangements have been work out beforehand. All prepaid sessions must be used within 180 days from first session date. I will forfeit any remaining sessions at that point.10. I understand that I when purchasing a series of sessions that I am getting a discounted price and no refund will be issued for unused sessions.
 

DISCLOSURE STATEMENT

CANCELLATION POLICY

 
Appointments need to be cancelled no less than 24 hours in advance except in the case of an emergency. However, if this is abused you will be charged the missed appointment fee of $50. When appointments are missed, or cancelled within 24 hours it makes it impossible for me to give that time to someone else.


CONFIDENTIALITY

All manners of our sessions will remain confidential unless you are in danger of hurting yourself or others, child abuse or in the case of subpoena of records. Information will not be released to other medical professions without a signed consent form.

PHONE CALLS AND EMAILS BETWEEN SESSION

 
There will be no change for brief phone calls or emails between sessions. Any call that takes longer than 20 minutes will be billed at $0.75 per minute.

New Client Intake Form

Please download the following form and fill out all fields. When complete email to sraymond@cofdg.com Thank you!