Quantum Regression Agreement Form

In the event of a schedule change or emergency, client will be contacted directly by phone.
NOTE: Provide general comments at the very least but any information will be useful in preparing for the session appropriately.
Your date of birth is required to confirm you are of legal age.
NOTE: Provide any additional information you may feel is relevant to the booking of this session including any/all prescription medications used for anxiety, depression, seizures or pain. Please advise if you have ever been treated for schizophrenia, MPD, psychosis or PTSD.