I understand that I have entered into an agreement with David Gruben, of FRMS Hypnosis, for the sessions that I have booked with him at his office, or via Skype.

I have marked my sessions accurately in my calendar and understand that I will not receive a reminder call or notification prior to my session dates. (I will call to confirm dates if necessary.)

I understand that the time allotted for my sessions is reserved specifically for me, and a 24 hour notification for a cancelled or rescheduled appointment is necessary. If adequate notification is not given I will be charged for the session in full.

If area schools close due to weather conditions, I will not be charged for the session, however I must re-schedule another appointment at a suitable time, within 72 hours of the original appointment to replace the original appointment.

I may also opt to conduct my session via Skype over the internet. To utilize Skype I must have a computer that is equipped with a web-cam and have the program Skype downloaded on my computer prior to the scheduled appointment.


Client Name: ______________________________________________________

Date: ___________________________________________________________

Billing Address: ____________________________________________________

City: ______________________________________________ State:                   

Phone: ___________________________ E-mail:                                                    

Client’s Signature:                                                                                                     

Circle One: Visa, Master Card or American Express

Card #_______________________________________________________

Expiration Date:                                                       CV Code:                         

Name as it appears on the Card: ______________________________________________


Success with hypnosis is dependent on many variables, including your attitude as a client, your follow-through, your adherence to the program, and your personal health and history. Please consult your physician before beginning any health program.

A consulting hypnotist can and will teach you techniques that can help you manage the everyday, ordinary problems we all have. FRMS Hypnosis does not diagnose, treat, or prescribe for any psychological or medical disorders. If you suffer from a psychological or medical disorder, please consult your physician or mental-healthcare professional.