PLEASE READ AND SIGN: *

First Name

Last Name

Birthday *

MM

DD

YYYY

Time You Were Born (am/pm?) *

Please just type in your birth time, do not worry about the time zone. Just mark your birthtime at the place you were born.

Hour

Minute

Second

AM PM

Children? *

Do you have children?

Yes

No

Consent Signature *

PLEASE READ AND SIGN: Thank you for choosing to step into this work. Before we begin, I invite you to take a moment to read and sign this consent form. It is a vital part of our sacred agreement—an honoring of both your autonomy and the energetic space we are co-creating. While hypnosis, regression, meditation, and coaching are powerful tools for self-discovery and transformation, they are not a substitute for licensed medical, psychological, or psychiatric care. Your well-being is always your own, and this work is here to support you—never to diagnose, prescribe, or replace professional healthcare. We share this space in mutual trust and presence. Client Acknowledgement & Agreement By signing below, I acknowledge and agree to the following: I understand that each person’s process is unique, and while many experience significant insight or transformation, results cannot be guaranteed. I understand that hypnosis, hypnotherapy, regression, or coaching are not medical treatments, and Becca Lynn does not diagnose or treat any physical or psychological conditions. I consent to gentle, appropriate touch (such as shoulder, hand, wrist, or forehead) if needed to guide me into a relaxed state during an in-person session. I recognize myself as an active participant and co-creator in my own healing process, and I take full responsibility for my experience and participation. I understand that I am free to pause or end any session at any time, and that my free will is always honored. I understand and respect the strict confidentiality policy. Everything shared in our sessions will remain private and protected. This confidentiality extends to minors under the age of 18, with appropriate ethical considerations. I agree to arrive on time for my session and to give at least 24 hours’ notice for cancellations or rescheduling. I give my full, informed consent to receive hypnosis, regression, and/or soul coaching sessions with Becca Lynn. Empowered Participation To support the success of our work together, I agree to: Accept full responsibility for my thoughts, choices, energy, and actions. Recognize that blame—toward others or myself—disempowers my process. Understand that my inner reality (thoughts, emotions, perceptions) shapes my outer experience. Participate with openness, willingness, and integrity—both during our sessions and through any integration practices or reflections between them.

First Name

Last Name