Custom Hypnotherapy Script & Guided Recording Intake

Provide the information below so I can create a grounded, effective hypnotherapy script or guided recording tailored to your goals.

Full name

Email address

What is your primary goal for this script or recording?

What is currently getting in the way or causing difficulty?

What tone do you prefer?

Is this for personal use or for your clients?

Personal use

For my clients

Both

Do you want a script, a recording, or both?

Script only $100

Script + Recording $200

Preferred length

Sections of Script to Include

Are there any specific phrases, themes, or boundaries you want included or avoided?

Anything else you want me to know before I begin?

Disclaimer & Consent

I understand that the custom hypnotherapy script or guided recording I am requesting is a non‑clinical, non‑medical supportive tool. It is not a substitute for medical care, mental health treatment, or professional therapy. No diagnosis, treatment, or medical advice is being provided.

I understand that results vary and are not guaranteed. I take full responsibility for my own well-being and for how I choose to use the script or recording. I agree that I will not use this material as a replacement for medical or mental health support, and I will seek appropriate professional care if needed.

By submitting this form, I acknowledge that I am voluntarily requesting this service, that I am participating by choice, and that I release the creator from any liability related to my use of the script or recording.

I have read and agree to the Disclaimer & Consent above.