Pracitioner Georgeanna DeCarlo
I understand that this hypnosis session in no way replaces medical or other treatment.
I am 100% responsible for myself and my own health and well being.
I am not currently on anti psychotic or other drugs including alcohol, which are affecting my mental state.
Georgeanna is not responsible for any outcomes from this Quantum Healing session.
Spontaneous healing can and often does occur.
PERMISSION FOR CASE STUDY TO BE USED
I give my consent for my unidentified session to be used, published, or distributed, in any manner by Georgeanna DeCarlo. Any personal information - name, age, and occupation will be changed. Gender and minor details may also be changed so it does not identify me in any way.
City / Town: ______________________ Occupation __________________
Year of Birth: ______________________ Birth City ___________________________
Date: _____ Signature: ______________________