Client Intake Form

If you would like a private appointment in the south-west Toronto location, you can book your time online using booking software.

You can also just peruse what dates and times have availability.

Please note that there is some wiggle room...contact me if you need to make a change.

To review what appointment times are available;

also to book an appointment


The Intake Form (see below) is for clients booking an appointment for the first time.

You should have received confirmation of your appointment day and time. If not, please contact me at 416 255 8333.

If you prefer a paper form, I can send you a Word document, or you can pull together this information and email it to me. 

Parking is free and TTC access is available. For more detail on the location, click here.


Appointment Fee:

The appointment fee is $200 Initial and $175 subsequent (two hour blocks).

One hour Skype/phone is $100.

Personalized recordings are $100.

HST is applicable on all services.

Please note that fees are subject to change; notice will be posted on the site.


Payment Choices:

Payment choices include:

  • email transfer
  • cheque
  • cash
  • credit card ($6 service charge applicable per transaction).


Regarding cancelling an appointment prior to 24 hours:

This time frame provides an opportunity to fill the spot with another client; no charge for the missed appointment is made.

If you have pre-paid for your service, a full refund is available if payment was made by email transfer ($5.00 service fee for credit card transactions). This fee can be avoided if you opt for a service credit instead of a refund.

Cancelling with less than 24 hours notice:

If cancelling with less then 24 hours notice, the fee is equal to half the cost of the missed appointment. For pre-paid services, the remaining balance will become a service credit and will not be refunded.

No Show:

If a client does not call and does not attend an appointment, the fee is equal to the full cost of the missed appointment. No refunds are given for pre-paid services.


Regarding the Intake Form:

Your information is kept confidential.

I am only able to speak to your careprovider (or anyone else) with your express permission.

As hypnosis is capable of significantly reducing the conscious perception of pain, anyone wishing hypnosis for pain relief for a medical condition must provide a doctor's letter.

Hypnosis for stress relief and relaxation do not require a medical letter. Other modalities (i.e. Tapping/EFT) can address other aspects of issues surrounding pain and do not require a doctor's letter.

Hypnosis is contraindicated for anyone with epilepsy, schizophrenia, and DID (Dissociative Identity Disorder). I do not provide services for anyone who has any of these conditions.


Intake Form:
General

Please note that all fields followed by an asterisk must be filled in.
home phone
business phone
cellphone
text
email
I do not have any of these diagnoses
I have received a diagnosis of one (or more) of these
none
heart disease
high blood pressure
chronic pain
medically diagnosed mood (i.e. depression, anxiety)
psychiatric care (i.e. bipolar, OCD, other)
other
daytime - weekday
daytime - weekend
evening - weekday
other
Yes
Other
Yes
Not now, thank you
Other


By completing the Intake Form, you agree to the following Terms and Conditions and Privacy Policy:

Please take a moment to review this link:

Privacy Policy

Thank you!



Socializing...




Relaxation Evening:
General

Tuesday May 30

7.30 pm to 9 pm

Home office (west end Toronto) location.

No charge to attend, but reservations are required.

416 255 8333



Relaxation Evening: 
Fertility Focus

Monday May 15

or

Monday June 12

6.50 to 8.30 pm

ALIVE Holistic Health

Carlton and Yonge

No charge to attend, but reservations are required.

This evening is open to those with fertility challenges.

Whether planning natural conception, IUI or IVF, this is a time for you to just relax and feel good.