Intake Form
This Form is to be filled out, signed and submitted prior to your session.  

                   Mind Over Matter                  
Rapid Transformational Therapy (RTT) and
                                    Quantum Healing Hypnosis Technique. (QHHT)                                            
ALL INFORMATION IS STRICTLY CONFIDENTIAL​

What brings you in today?
Anything on this list, or something else? ​

Achieving goals,
Addictions
Anxiety
Career
Childhood problems
Concentration
Confidence
Compulsive Behavior
Depression
Drinking, Drugs, Gambling, Smoking  
Exam Stress
Eating Disorders
Fears
Guilt
Motivation
Memory
Pain
Control
Panic
Phobias
Public Speaking
Relaxation
Self Esteem
Skin Complaints
Stress
Relationships
Weight Issues
​Past Life Regression- QHHT
Spiritual insights and growth, and questions for your Higher Self -QHHT
Dealing with a health issue whether small or big and want to get to to the root cause of it -QHHT

​​Disclosures:People with Epilepsy or any person diagnosed as having a psychotic illness should not enter hypnosis. MindOverMatter accepts no responsibility whatsoever, under no circumstances including but not limited to negligence,  and cannot be held liable for any special or consequential damages in any way whatsoever now or in the future that result from the use of hypnosis, advanced hypnotic techniques, hypnotherapy or any other therapies, or any information gained while relaxed and in hypnosis. The information, techniques, methods and recommendations by MIndOverMatter are not intended to substitute for the diagnosis and care of a qualified doctor. At no point is anything that is said during this session by the hypnotist, or the client, while under hypnosis, to be constituted as “advice”, the client must always use discernment when taking any actions or changes of action in their life after a session. If you use hypnosis and are under medical care for any condition, do not make any adjustments to any prescribed medication without the approval of your doctor. If in any doubt, you should seek medical advice.  I, Leanne Hamilton do not accept responsibility for any loss, damage or expense resulting from the use of information provided. By signing this form you are agreeing to these conditions and you indemnify Mind Over matter and Leanne Hamilton, and hold us harmless . Never drive a vehicle while listening to hypnotic audio. The information I have given here is to the best of my knowledge, full and correct. These sessions are taken with the understanding that this  is a collaborative process, and that progress depends in large part upon your own motivation, and participation. 

I accept that all appointments not cancelled with 48 hours will be charged in full.
By providing my name and signature below I am agreeing to the terms, conditions and disclosures.