Physician Referral / Consent for Hypnosis
If you are seeking hypnosis for a diagnosed medical or mental-health condition that is currently under a provider’s care, I ask for a Physician Referral / Consent for Hypnosis form from your provider before we work on that condition. Your provider can complete the secure online form using the button below. You can also download or print this form, then email it back to [email protected], or text a clear photo of it to 479-256-0211.
Download the Physician Referral / Consent PDF
Questions? Call or text Dana at 479-256-0211.