Client History

If you have decided to permanently rid yourself of those feelings and emotions or that physical problem that’s been bothering you, fill out the Online Client Form below.

Fill out the form and I will then send you the dates and times available for sessions and then you can pick according to your schedule.

Free consultation by phone contact 403-816-2671
E-mail contact

Note: All the information on this form is 100% confidential and will be used to help us understand your life and your needs in hypnotherapy and hypnosis.

Your email address will never be sent, shared or sold to any third party.

Advanced Hypnosis

Client History Form

Address *

Important! Please Read the Following

Please remove contact lenses before the session. They may inhibit your ability to completely relax. Please use the bathroom before the session as that may also inhibit relaxation.

Please read the statement and if you agree please acknowledge by selecting agree, or disagree by selecting disagree.

I hereby authorize, Wally Muller, to hypnotize or use guided imagery with me for the purposes outlined in (reasons for coming for hypnosis/guided imagery) and for any future purposes I request.

I understand that the results of my hypnosis/guided imagery depend greatly on my own ability to relax and the desire to create change.

I understand that the result(s) achieved from my session(s) depends greatly on my serious participation.

I understand that hypnosis/guided imagery is not a medical or psychological procedure.

I am aware and trust that Wally Muller will do everything reasonable in his power to ensure my success.

I understand that the hypnosis/guided imagery sessions will be audio or video recorded for any followup session’s, continuity or training and all sessions are completely confidential.

Wally Muller does not offer any guaranties as to the success of my session(s).