Quantum Healing Hypnosis Technique® (QHHT) Client Intake, Consent & Waiver Form

Practitioner: Natasha Burton
Business Name: The Lotus Healer (ABN 80 931 395 996)

INTRODUCTION

QHHT is a holistic hypnosis modality developed by Dolores Cannon. Sessions are intended to facilitate personal insight, self-exploration, spiritual understanding, and communication with the client’s own subconscious or Higher Self.

All information disclosed during your session is treated as private and confidential and will be handled in accordance with applicable Australian Privacy Laws.

Please read this document carefully and complete all sections before your session.

IMPORTANT SESSION INFORMATION

The entire QHHT session will be audio recorded.

A digital copy of the recording will be provided to the client within seven (7) days following the session.

Because clients often do not consciously remember all or part of the hypnosis experience, listening to the recording multiple times is strongly encouraged.

IMPORTANT SAFETY NOTICE:

The client agrees that they will NEVER listen to the recording while:

Driving
Operating machinery
Supervising activities requiring full attention
Engaging in any activity where relaxation or altered focus may create a safety risk

The recording may induce a deeply relaxed state and should only be listened to in a safe environment.

UNDERSTANDING THE QHHT SESSION

SECTION A – Personal Interview Process

Prior to hypnosis, a detailed personal interview lasting approximately 2–3 hours will be conducted.

During this discussion, the practitioner may ask questions regarding:

Childhood experiences
Family relationships
Parents and siblings
Marriage and partnerships
Children
Personal challenges
Career and life circumstances
Physical health concerns
Mental and emotional wellbeing
Trauma history
Significant life events
Accidents and injuries
Spiritual beliefs and experiences

This information assists the practitioner in identifying themes, patterns, and areas of inquiry that may be explored during the hypnosis session.

The client understands that sensitive subjects may arise during this discussion and agrees to participate honestly and openly to the extent they feel comfortable.

SECTION B – Hypnosis and Higher Self Communication

Following the interview process, the client will be guided into a deeply relaxed Theta brainwave state through visualisation techniques and spoken-word hypnosis.

The hypnosis portion typically lasts approximately 1–2 hours.

The client understands that:

• Theta is a natural and normal brainwave state.
• The client remains safe throughout the session.
• The client cannot become “stuck” in hypnosis.
• The client may remember all, part, or none of the experience.
• The client remains free to communicate during the session.
• The practitioner does not control the client’s mind, thoughts, or actions.

During the session:

The practitioner may guide the client to the most appropriate past-life experience or symbolic experience for healing and understanding.

The practitioner may then facilitate communication with the client’s Higher Self, Subconscious Mind, or Inner Wisdom.

Questions prepared by the client may be asked.

The client’s Higher Self may provide insight, guidance, perspective, or healing information.

In some cases, the Higher Self may indicate energetic, emotional, spiritual, or symbolic healing processes.

The client understands that experiences and information received during hypnosis are subjective in nature and may be interpreted differently by different individuals.

CURRENT HEALTH INFORMATION

Please list any current medical conditions, injuries, discomfort, diagnoses, medications, mental health concerns, emotional challenges, psychological conditions, or other relevant information.

QUESTIONS FOR YOUR HIGHER SELF

Please list up to fifteen (15) questions you would like asked during your session.

Examples may include:

• What is my life purpose?
• What lessons am I here to learn?
• What career path is most aligned for me?
• How can I improve my relationships?
• What is the origin of a recurring issue in my life?
• How can I heal emotionally, mentally, physically, or spiritually?
• What happens after death?
• How can I clear karma?
• What soul contracts am I currently working through?

Curiosity and exploration are encouraged.

PART 5 – INFORMED CONSENT

I acknowledge and understand that:

I am voluntarily participating in a QHHT session.
QHHT is a complementary and spiritual self-exploration modality.
The practitioner is not a doctor, psychiatrist, psychologist, counsellor, or licensed healthcare provider unless otherwise stated.
No medical diagnosis, treatment, prescription, or medical advice is being provided.
Information received during hypnosis should not replace professional medical, psychological, legal, or financial advice.
Any decisions I make following the session are my own responsibility.
I understand that the practitioner acts only as a facilitator and intermediary in the communication process.
Results vary from person to person.
No guarantees regarding outcomes, healing, spiritual experiences, or life changes have been made.

LIABILITY WAIVER AND RELEASE

Participation in QHHT is voluntary.

I accept full responsibility for my own physical, emotional, psychological, spiritual, and personal wellbeing before, during, and after the session.

I understand that no claims of medical diagnosis, treatment, cure, or guaranteed outcomes have been made.

I understand that information obtained during hypnosis may be subjective, symbolic, metaphorical, spiritual, personal, or open to interpretation.

I agree that any decisions, actions, or changes I make as a result of the session are my sole responsibility.

To the fullest extent permitted by law, I release and hold harmless Natasha Burton, The Lotus Healer, its representatives, successors, and affiliates from any and all claims, liabilities, losses, damages, injuries, costs, or expenses arising directly or indirectly from participation in the session.

I understand that this waiver does not exclude rights that cannot legally be excluded under Australian Consumer Law.

By signing below, I acknowledge that I have read, understood, and voluntarily agree to the terms contained in this document.

Quantum Healing Hypnosis Technique® (QHHT) Client Intake, Consent & Waiver Form

Practitioner: Natasha Burton Business Name: The Lotus Healer (ABN 80 931 395 996)

INTRODUCTION

QHHT is a holistic hypnosis modality developed by Dolores Cannon. Sessions are intended to facilitate personal insight, self-exploration, spiritual understanding, and communication with the client’s own subconscious or Higher Self.

All information disclosed during your session is treated as private and confidential and will be handled in accordance with applicable Australian Privacy Laws.

Please read this document carefully and complete all sections before your session.

IMPORTANT SESSION INFORMATION

The entire QHHT session will be audio recorded.

A digital copy of the recording will be provided to the client within seven (7) days following the session.

Because clients often do not consciously remember all or part of the hypnosis experience, listening to the recording multiple times is strongly encouraged.

IMPORTANT SAFETY NOTICE:

The client agrees that they will NEVER listen to the recording while:

Driving

Operating machinery

Supervising activities requiring full attention

Engaging in any activity where relaxation or altered focus may create a safety risk

The recording may induce a deeply relaxed state and should only be listened to in a safe environment.

​

UNDERSTANDING THE QHHT SESSION

SECTION A – Personal Interview Process

Prior to hypnosis, a detailed personal interview lasting approximately 2–3 hours will be conducted.

During this discussion, the practitioner may ask questions regarding:

Childhood experiences

Family relationships

Parents and siblings

Marriage and partnerships

Children

Personal challenges

Career and life circumstances

Physical health concerns

Mental and emotional wellbeing

Trauma history

Significant life events

Accidents and injuries

Spiritual beliefs and experiences

This information assists the practitioner in identifying themes, patterns, and areas of inquiry that may be explored during the hypnosis session.

The client understands that sensitive subjects may arise during this discussion and agrees to participate honestly and openly to the extent they feel comfortable.

​

SECTION B – Hypnosis and Higher Self Communication

Following the interview process, the client will be guided into a deeply relaxed Theta brainwave state through visualisation techniques and spoken-word hypnosis.

The hypnosis portion typically lasts approximately 1–2 hours.

The client understands that:

During the session:

The practitioner may guide the client to the most appropriate past-life experience or symbolic experience for healing and understanding.

The practitioner may then facilitate communication with the client’s Higher Self, Subconscious Mind, or Inner Wisdom.

Questions prepared by the client may be asked.

The client’s Higher Self may provide insight, guidance, perspective, or healing information.

In some cases, the Higher Self may indicate energetic, emotional, spiritual, or symbolic healing processes.

The client understands that experiences and information received during hypnosis are subjective in nature and may be interpreted differently by different individuals.

​

CURRENT HEALTH INFORMATION

Please list any current medical conditions, injuries, discomfort, diagnoses, medications, mental health concerns, emotional challenges, psychological conditions, or other relevant information.

​

QUESTIONS FOR YOUR HIGHER SELF

Please list up to fifteen (15) questions you would like asked during your session.

Examples may include:

Curiosity and exploration are encouraged.

​

PART 5 – INFORMED CONSENT

I acknowledge and understand that:

I am voluntarily participating in a QHHT session.

QHHT is a complementary and spiritual self-exploration modality.

The practitioner is not a doctor, psychiatrist, psychologist, counsellor, or licensed healthcare provider unless otherwise stated.

No medical diagnosis, treatment, prescription, or medical advice is being provided.

Information received during hypnosis should not replace professional medical, psychological, legal, or financial advice.

Any decisions I make following the session are my own responsibility.

I understand that the practitioner acts only as a facilitator and intermediary in the communication process.

Results vary from person to person.

No guarantees regarding outcomes, healing, spiritual experiences, or life changes have been made.

​

LIABILITY WAIVER AND RELEASE

​

Participation in QHHT is voluntary.

I accept full responsibility for my own physical, emotional, psychological, spiritual, and personal wellbeing before, during, and after the session.

I understand that no claims of medical diagnosis, treatment, cure, or guaranteed outcomes have been made.

I understand that information obtained during hypnosis may be subjective, symbolic, metaphorical, spiritual, personal, or open to interpretation.

I agree that any decisions, actions, or changes I make as a result of the session are my sole responsibility.

To the fullest extent permitted by law, I release and hold harmless Natasha Burton, The Lotus Healer, its representatives, successors, and affiliates from any and all claims, liabilities, losses, damages, injuries, costs, or expenses arising directly or indirectly from participation in the session.

I understand that this waiver does not exclude rights that cannot legally be excluded under Australian Consumer Law.

By signing below, I acknowledge that I have read, understood, and voluntarily agree to the terms contained in this document.

Practitioner: Natasha Burton
Business Name: The Lotus Healer (ABN 80 931 395 996)