Quantum Regression Agreement FormPlease enable JavaScript in your browser to complete this form.Name *FirstMiddleLastEmail *Contact Number *In the event of a schedule change or emergency, client will be contacted directly by phone. Select your preferred session type *Quantum Healing Hypnosis Technique (QHHT)Beyond Quantum Healing (BQH)Angelic Universal Regression Alchemy (AURA) Hypnosis Healing TechniquePreferred method *QHHT (in person only)BQH or AURA In personBQH or AURA OnlineI have been hypnotized before *YesNoUnsuccessfully (please clarify below)My main reasons for wanting to be hypnotized are... *NOTE: Provide general comments at the very least but any information will be useful in preparing for the session appropriately.Date of Birth *Your date of birth is required to confirm you are of legal age.I am of legal age and voluntarily wish to participate in this Quantum Regression session with Ali and understand that Ali is not a doctor, nor does she hold a degree in Psychiatry or Medicine. She can neither diagnose nor treat any type of physical or mental disorder nor is hypnosis a substitutes for regular medical care. *AgreeI understand that I am not a patient, but a co-creator in my Quantum Regression experience. I understand that any subsequent self-healing involves self care physically, mentally, emotionally and spiritually which may take time. *AgreeI understand that all information I give for the purpose of the session will be held as strictly confidential and that any misleading information I provide or information that is purposely omitted may skew the session. *AgreeI have not consumed recreational drugs or alcohol prior to session. *AgreeAdditional informationNOTE: 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. Submit