incontinence waiver

By completing the form below, you are requesting to begin sessions relating to incontinence.  This is a major life decision, and will not progress without the completion of this form as well as the consent of your hypnotherapist.  Please understand that your hypnotherapist may, at any time during the progress of the sessions, decide that this aggressive treatment is no longer in your best interest.  

Please complete the form below to begin the process.