Pick the format that is right for you.

(Free Relaxation Mp3 at the bottom.)

Download and print out both the Intake Form and Benefits Desired Form. Fill them out and bring with you. Use the backs of the forms to write down any questions that you may have. This way, you can concentrate on the answers and not worry about remembering the next question.

CPHC Intake Form & Benefits Desired Form

                        .PDF – click here


Doctor Referral Form

If you are already under a Medical Doctor’s, Psychiatrist’s or Psychologist’s or Psychotherapist’s care for the same problem that you are seeking help through hypnosis, please print out this form and have him/her fill it out and mail it to the address on the form

                        .docx – here

                        .doc – here

                        .pdf – here


Free Relaxation MP3  – Here