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Release.Realign.Rise

It is time to become who you were born to be

Manifestation Mastery Intake Form

Are you sure about the time? (it affects the analysis)
Yes
No
Are you currently taking any medication?
Yes
No

Disclosure Consent


Andrea Correia does not treat, prescribe for, or diagnose any condition. She is a properly trained and certified hypnotherapist and is not practicing any other profession that requires a license under the laws and regulations of the State of Florida. Hypnosis is not a substitute for medical or psychological treatment. Hypnosis for subclinical purposes requires no referral. She only practices therapeutic hypnosis within the guidelines of the law and Florida Statute 485, which requires a referral and oversight from a licensed practitioner of the healing arts. By signing below, I acknowledge that I have read and understood this Disclosure and give My Consent to be hypnotized for the purpose of helping me achieve the goal(s) I have described above.


I understand that I will be charged for any session canceled with less than 24 hours' notice. I understand that Andrea Correia offers no refunds and only credit for any unused portion of any multi-session program.


Packages can be refunded if requested by email within 24 hours after the first session of that package. Refunds will not be processed after these 24 hours following the first session.


The number of sessions required is an estimate. Each individual's process is unique, and the actual number of sessions may vary. The need for additional sessions will be discussed with the client during the process.


Single sessions can be purchased to complement ongoing program work.


There is a 15-minute tolerance for late arrivals, both in-person and online. After this period, the session will be canceled and you will be fully charged.


I further permit Andrea Correia to record my session and to discuss my case with my physician, if appropriate.


By typing my name, I'm confirming my agreement, just as if I had signed in person.

@ 2025 Andrea Correia Hypnosis & Wellness

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