Client Intake Form

If you would like a private appointment online, 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. 


Appointment Fee:


Standard appointments, two hours:

$210 Initial* and $185 second and subsequent.


Pandemic Option - Pay What You Can/PWYC, one hour:

your choice of $55, $75, or $105. 


HST is applicable on all services.


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


* The higher fee represents access to a private link loaded with resources (mp3, pdf and more) to support the changes you want.

Any hypnosis recordings that I have currently available for purchase are loaded to this private link freely available for your use.


The Standard Appointment is good for lasting change. We will chat and use a number of modalities. We have a chance to access detail that can be helpful.

The Pandemic Option reflects our changing times - everyone is affected differently. You choose the amount that works best for you. This option is for new clients and current clients. Think of this as a booster - to get you through the day, get over a hump, change how you think and feel in one hour.

With Zoom appointments, the hypnosis component is recorded separately and you will receive an mp3 copy by email.


Payment:

Payment choices include:

email transfer

For American/international clients, PayPal works well.

SquareUp is also available.

For PayPal and SquareUp payments, an additional 5% before tax is applied to cover service charges billed to me.

The appointment fee is in Canadian dollars plus 13% tax.


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 (plus $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.



IF the online form is not working for some reason,

email me with your preferred date and I will 

send a Word document that can be completed.


shawn at childbirthjoy dot com

or call: 416 255 8333




Intake Form:
General

Intake Form

Please note that all fields followed by an asterisk must be filled in.

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