DATE .__________________202__

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This is what you fill out when you come to the office.

If online and in ZOOM, then copy and email this to me.

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Candace Durand CHT Applications and Personal Data Record and Release Form: Please print this page and fill it out completely in blue or black ink. Then scan and resend by email or post. This will not be released to anyone at your request. durandcandace@gmail.com.

Copy this page or print it. Send to email. Please give me 24 Hours’ notice of cancellation. I take an hour sometimes to get ready for your session. If your session is more than 2 hours, I may request a deposit to secure your appointment and ensure you are prepared for this process.

 

_birth date day month and year--.______________________________________________ ____________________________________________________________________________________________________________

 

_Email print plainly text._____________________________________________________________

 

_Time zone MST, EST, PST, CST, or daylight time also

phone_____________________________________________________________

Occupations of (yourself_) __

__________________________________________

Female/male-/ nonbinary,  circle one

Marital status _ Choose an item.Y / N         

                First name of partner                      _

______Occupation of partner______________________________________________

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Emergency contact_______________________________________________Cell_ ______________

 

 

 

_How did you find me?

____________________________

 

 

 

On a separate piece of unlined paper, write down in longhand what you want to accomplish in our work together. Please include questions (no more than 15) for QHTT sessions, Quantum Healing Hypnosis Technique. Just write down what you want to achieve in a short paragraph. I can read handwriting. If you have a hand issue and cannot write, just voice mail me your issues you want to address. Sign the paper at the bottom, please. Use cursive if you know it or if you can remember it. If I send this. Scan all of this and try to make it black and white, not brown, put it under a strong white light to send to me by text, or via email, or send it by post. In care of Candace Durand, 2302 Rosebud Drive, Billings, MT, 59102 or durandcandace@gmail.com

Before a session, practice sitting quietly for 20 minutes. Focus on one thought and breath. Eat lightly before a session. Please no caffeine before a session. Try to stay away from caffeine for 3 hours. I would like you to be tired but not sleepy.