I, understand all questions and verify that all information is complete and accurate to the best of my knowledge. I also understand that the hypnotic methods used by FLOURISH HYPNOSIS are not a substitute for medical or psychiatric treatment. I understand these methods to be a conditioning process, whereby an individual is taught to use their own abilities for their benefit and well – being. With this understanding, I hereby grant FLOURISH HYPNOSIS permission to hypnotize me or the minor child whose name appears at the top of this form. I know my progress is dependent upon my efforts and that there are no guarantees as to the result or progress to be made. I understand that the success of the treatment will be in direct proportion to my commitment to the end result.