Online Consent Form

Name

Address

Phone Number

Email Address

Age

Please read this carefully:

I clearly understand that Jennifer Riggs is a Hypnotist / Hypnotherapist as defined by the Laws of the State of Pennsylvania. I clearly understand that Jennifer Riggs is not a Medical Doctor, nor a Psychologist, nor a Psychiatrist, and does not treat medical nor emotional disorders or diseases.

I am not undergoing medical, psychological or psychiatric treatment that would prevent me from participating in hypnosis. I am ready and willing to be hypnotized. I am of legal age and chose to experience Hypnosis and Hypnotherapy under the guidance of Jennifer Riggs.

I hereby release Jennifer Riggs from any and all liability, because I understand that if I have any questions about my session, or anything pertaining to Hypnosis or Hypnotherapy, that I will ask questions to learn the answers to my satisfaction before proceeding with any aspect of my Hypnotherapy session.

**Payment for each session is due at the end of the session, unless arrangements are made in advance.

I Confirm:Yes