QHHT Client Intake & Consent

A Few Details Before We Begin 

Your Quantum Healing Hypnosis Technique session is booked, and I’m looking forward to connecting with you. Before we meet, please take a few moments to complete the client intake and consent form below. Your responses will help me better understand what is bringing you to QHHT® and anything that may help me prepare for and support you during our time together.

QHHT® Informed Consent 

Please review the following information carefully. By checking the required acknowledgment within the client intake form and submitting the form, you confirm that you have read, understand, and voluntarily agree to the following:

1. Nature of QHHT®

I understand that Quantum Healing Hypnosis Technique (QHHT®) is a hypnosis and regression technique developed by Dolores Cannon. A session may involve an extended interview and life review, guided relaxation and hypnosis, regression experiences that may be perceived as past lives or other meaningful experiences, and communication with what QHHT® refers to as the Subconscious, which some individuals may understand as the Higher Self.

I understand that experiences during hypnosis are highly individual. I may experience memories, imagery, emotions, physical sensations, symbolic material, spiritual experiences, intuitive impressions, or other subjective content. I understand that no particular type of experience is guaranteed and that material arising during hypnosis should not automatically be interpreted as objectively or historically factual.

2. Scope of Practice & Professional Care

I understand that QHHT® is offered by Astralis Healing as a spiritual and personal-growth practice and is not medical care, psychotherapy, psychiatric treatment, diagnosis, or another licensed healthcare service.

Astralis Healing, LLC and Jordyn Kurtz do not diagnose medical or mental-health conditions, prescribe medications, provide medical or psychiatric treatment, or advise clients to discontinue or alter treatment prescribed or recommended by a licensed healthcare professional.

QHHT® is not intended to replace appropriate medical, psychological, psychiatric, legal, or other professional care. I remain responsible for determining when care from an appropriately qualified professional is needed.

3. Hypnosis, Regression & Voluntary Participation

I understand that my participation in QHHT® and hypnosis is voluntary. I may communicate discomfort or concerns during the session and may choose to discontinue the hypnosis or session at any time. I understand that choosing to discontinue hypnosis after it has begun concludes the hypnosis portion of my scheduled appointment, as further described in Section 9.

I understand that hypnosis and regression may bring forward unexpected emotions, memories, imagery, sensations, beliefs, spiritual material, or other subjective experiences. Some experiences may feel meaningful, vivid, emotional, or personally significant.

I understand that QHHT® does not guarantee that I will experience a past life, communicate with the Subconscious/Higher Self, receive answers to particular questions, experience healing, or have any other specific experience or result.

4. Session Preparation, Questions & Aftercare

I understand that QHHT® sessions are extended sessions and that I should plan accordingly for the time required.

I agree to arrive prepared for my session and to bring a list of the questions I would like to explore. I understand that I do not need to submit these questions in advance and may continue adding to my list until the day of my appointment.

I am encouraged to arrive well-rested and adequately hydrated and to follow any preparation instructions provided by Astralis Healing.

Following my session, I understand that integration continues beyond the appointment itself. I agree to follow the aftercare and integration guidance provided by Astralis Healing, including listening to my session recording as directed. I may also experience continued reflection, emotional processing, vivid dreams, new insights, fatigue, or other subjective experiences following the session. Individual experiences vary, and I am encouraged to allow appropriate time for rest, hydration, grounding, reflection, and integration.

5. Individual Experiences & Personal Responsibility

I understand that QHHT® experiences and responses vary significantly between individuals and that there is no predetermined or guaranteed response to hypnosis or regression.

I understand that insights, messages, imagery, memories, spiritual experiences, or other material arising during my session are subjective experiences. I am responsible for how I interpret this material and for any decisions or actions I choose to take based upon my session.

I agree not to use information arising during a QHHT® session as a substitute for professional medical, mental-health, legal, financial, or other appropriately licensed advice.

6. No Guarantees of Outcome

I understand that no specific physical, emotional, psychological, spiritual, relational, or other outcome is promised or guaranteed through QHHT®.

Jordyn Kurtz serves as the facilitator of the QHHT® process. I understand that the depth of hypnosis, experiences accessed, information received, and my interpretation and integration of the session may vary.

7. Privacy & Confidentiality

Information I provide through my client intake form or share during an individual QHHT® session will be treated with care and handled in accordance with the Astralis Healing Privacy Policy.

I understand that information may be disclosed where required by applicable law or when I have provided appropriate authorization.

Astralis Healing will not intentionally use identifiable information, private session details, photographs, recordings, testimonials, or excerpts from my individual experience for marketing, advertising, social media, educational, or other public-facing purposes without my permission or other appropriate authorization.

8. Session Recording

I understand that the hypnosis portion of my QHHT® session will be audio & or video recorded and that this recording is an essential part of the QHHT® process. By participating in QHHT®, I consent to the recording of the hypnosis portion of my session for my personal use and continued integration.

I understand that the QHHT® process extends beyond the time spent in hypnosis during my appointment. Within the QHHT® framework, listening to my session recording afterward is intended to reinforce and integrate the intentions, insights, experiences, and healing work accessed during hypnosis and to continue engaging with the material at the subconscious level.

I understand that repeated listening to my recording is an important part of the integration process and is expected following my session. The recording provides an opportunity to revisit the session, notice information I may not consciously remember from hypnosis, and continue working with the intentions, insights, and experiences that arose.

I understand that choosing not to listen to my recording may significantly limit my ability to integrate and benefit from the session and may affect the results I experience. Astralis Healing cannot guarantee any particular outcome, regardless of how frequently I listen to my recording.

My recording is provided to me for my personal use. Astralis Healing will not intentionally publish, distribute, share, or use my recording for marketing, educational, social media, or other public-facing purposes without my express permission or other appropriate authorization.

9. Right to Discontinue & Session Time

I understand that my participation in QHHT® is voluntary and that I may choose to discontinue the hypnosis or session at any time if I experience discomfort or no longer wish to continue.

I understand that QHHT® sessions are conducted within a reserved appointment period and that entering the hypnotic state involves a guided induction process that requires a significant portion of the scheduled session time. If I choose to discontinue hypnosis after the induction or hypnosis portion of my session has begun, the hypnosis portion of my appointment will be considered concluded and will not be restarted during the same scheduled session.

I understand that my decision to discontinue is my voluntary choice and does not entitle me to a refund, credit, replacement session, extension of my appointment, or complimentary rescheduling. I acknowledge that Astralis Healing has reserved the appointment time and provided services through the point at which I elected to discontinue.

Any future QHHT® session would require a new appointment and would be subject to the applicable booking fees and policies in effect at that time.

Applicable cancellation, rescheduling, late-arrival, and no-show provisions are governed by the Astralis Healing Cancellation & Rescheduling Policy.

 10. Assumption of Responsibility & Release

I understand that I am voluntarily choosing to participate in QHHT® and accept responsibility for my participation in the session and for my personal interpretation, integration, and use of any information, imagery, memories, emotions, spiritual experiences, insights, or other material that may arise.

I understand that QHHT® may involve emotional, mental, physical, or spiritual experiences that cannot be predicted in advance and that individual responses vary. I accept responsibility for communicating relevant concerns before my session and for seeking appropriate licensed medical, psychological, psychiatric, or other professional care when needed.

I understand that any decisions or actions I take before, during, or following my QHHT® session remain my responsibility. I agree that I will not hold Jordyn Kurtz or Astralis Healing, LLC responsible for decisions or actions I take based upon my personal interpretation of information or experiences arising during QHHT®.

To the fullest extent permitted by applicable law, I knowingly and voluntarily assume the risks associated with participating in QHHT® and release and hold harmless Astralis Healing, LLC and Jordyn Kurtz from claims, demands, liabilities, damages, losses, or expenses arising from or related to my voluntary participation in QHHT®, except to the extent that liability cannot lawfully be waived or limited.

11. Agreement & Acknowledgment

I acknowledge that my purchase and participation are also subject to the applicable Astralis Healing Terms & Conditions, Privacy Policy, and Cancellation & Rescheduling Policy.

By checking the required acknowledgment within the client intake form and submitting the form, I confirm that I have had the opportunity to review this QHHT® Informed Consent, understand the information provided, have had the opportunity to ask questions, and voluntarily consent to participate in QHHT® services provided by Astralis Healing, LLC and Jordyn Kurtz.