I the undersigned, acknowledge that I understand and agree to the following:

I agree to pay you, Ted A. Moreno, C.Ht., a fee of $230.00 for an initial hypnotherapy session lasting 1 to 1 ½ hours. This will include a history of your presenting concern, theory of conscious and subconscious mind, suggestibility testing, inductions, deepening techniques, post hypnotic suggestions and immediate tools for self improvement.

Subsequent hypnotherapy sessions are 50 minutes at an agreed upon fee of $230.00. I also agree to pay you, in full, for your services, at the time of each session.

Program conditioning may include an undetermined number of private sessions based on individual needs and results may be quoted at no less than 3 consecutive sessions.

I agree to give you 24-hours notice by phone or text, not email, on all cancellations or changes regarding scheduled appointments. I understand that missing a previously scheduled appointment without prior notice or cancellation within 24 hours will result in a charge to me for the missed session at 100% of the full rate stated above.

I understand and agree that the major purpose of this program is for Vocational or Avocational Self-improvement and that those problems of a psychogenic or functional origin are treated by psychological or medical referrals only (Business and Professional Code 2908). I also understand that there are no guarantees as to the results or progress to be made, and that you will, to the best of your ability, endeavor to accomplish the objective of my sessions. Successful application of hypnotherapy techniques depends on cooperation, practice and by listening to personalized recordings made of the hypnosis portion of the session, emailed to me for no additional charge. For an additional charge of $10.00, I can choose to have a CD recording sent to me in the mail within 2 business days of the session. I may bring in my own personal recording device. All recordings are confidential and for private use.

Additional Information: Recommended: (Six Sessions for $1200) paid at first or second session.. (Save $230 dollars)

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