Contact Us

We are happy and ready to help answer any and all of your questions you may have. Please email us and we'll get back to you within 24-48 hours.

Electronic Intake Form

For your convenience, please complete the Electronic Intake Forms prior to your visit. Please follow these simple instructions to compete.

  • Click the HERE button to open the PDF file in the browser.
  • Once it opens, click FILE from the Mac toolbar.
  • Scroll down and click on, Export as PDF. Here you can save the file. We recommend your Desktop for easy access.
  • Once opened, please read carefully.
  • Place your cursor in the available fields, and tab through the fields to complete your information.
  • You will come across several electronic signature pages. Typing your name on the signature line indicates the same degree of acknowledgment and agreement as a hand written signature.
  • Save the file and return via email to, motivationalhypnotherapy@gmail.com, or complete the form below.. please don't forget to attach the PDF.

  • Allowed file extensions to upload: pdf