Part 1: Intake Form
All Fields Are Required

Have you ever been hypnotized by a professional?
  Yes No

Do you have any formal hypnosis training?
  Yes No  

Are you a professional health care provider?
  Yes No  

Do you want to pursue hypnotherapy as a career
or for your own personal development?
Personal Development Career Both

If you are interested in hypnotherapy as a career
do you intend to work full-time or part-time?
Full-Time Part-Time I'm Not Sure Yet

What is your current career?

Do you plan on working while you are taking the training?
  Yes No

What type of training would you like to take?
  Weekends Weekdays

Have you ever been self-employed?
  Yes No

What is your annual household income before tax?
Less than $30,000 $30,000 - $50,000 $50,000 - $70,000 $70,000 - $100,000 More than $100,000 Please Select...

List any other alternative health courses you've taken.
Example: Reiki, Healing Touch, Psych-K, etc.

Explain why you are interested in taking our courses.

List any health conditions you have, if any.

On a scale of 0 to 10 with '0 being no confidence at all'
and '10 being the most ever', how condifent would you rate yourself?

What do you consider to be your greatest strengths?

What do you consider to be your greatest weaknesses?

How did you hear about us? Please Select... Alpha University Amber Rockenbach Anne Veres Association of Registered Clinical Hypnotherapists (ARCH) Believe Hypnotherapy - Shannon Cartwright Body, Soul, Spirit Expo Calgary Dollars Check-Up Magazine Collaborative Health - Gemma Zinkan College of Hypnosis & Hypnotherapy International Medical & Dental Hypnotherapy Association (IMDHA) Inner Soul Guidance - Glenda Jordan Inner Source Guidance - Jeanne Lefevre Full Circle Hypnosis - Jennifer Alexander Life Intentions - Wendy Gorloo Margarita Muller Makoye Marketing - Donna Dahl People & Possibilities Magazine Prema Sai Wholistic Living Rising Women Magazine Shaw TV Style File - Marlene Zwicker Wholistic Living Magazine Yellow Pages OTHER
Other...



Additional Comments

Terms & Conditions:
PROGRAM PROVISIONS 1. Full Circle Hypnosis Inc. shall have the right to refuse admittance or to dismiss any person whom they deem to be unqualified for any program at any time. A refund may or may not be granted and is at the discretion of Full Circle Hypnosis Inc. 2. You will have a specific amount of time from the last day of each course to submit all your test requirements. If you have not submitted the required documents by the due date you will be subject to a $10 late submission fee and may be required to re-take the course at an additional fee. 3. You must meet each course pre-requisite prior to attending the course. If you are scheduled to take a course and you do not meet the pre-requisite required you will not be permitted to take the course until you have met the requirement. If you are within the 90 schedule change you forfeit the course fee and you will be required to pay again at the current individual course price if you wish to complete the course. 4. As a student you cannot charge money for your services, nor receive anything in exchange, until you are certified with the Association of Registered Hypnotherapists (or equivalent for non-Canadians). This applies unless you are a Psychologist, Clinical Counselor, Social Worker, Marriage and Family Therapist, Nurse or Doctor. All students must pass the pre-certification grading program in order to be recommended for certification. 5. Upon completion of the required courses, all students are required to apply for certification with the Association of Registered Clinical Hypnotherapists (or equivalent for non-Canadians). To be eligible for certification you must first complete the pre-certification grading process at Full Circle Hypnosis. 6. Some of our hypnotherapy and business packages are created with payment plans. Upon registration for these packages, you shall pay a down payment equal to or greater than the minimum required. Should you, for any reason, resign from these packages and not complete the programs you are registered for, you will be required to pay the regular price of any courses, programs, and/or products you’ve received and your down payment will not be returned nor applied towards any courses, programs and/or products, and will be used as an administration fee. 7. You agree to pay for each program in full or to provide post-dated cheques or by automatic monthly billing to the credit card given at the appropriate price and length of term, including applicable fees and taxes. Cheques are to be dated for the first of each month, prior to your first program. (Post-dated cheques must have your name clearly printed on the cheques and must be made payable to “Full Circle Hypnosis Inc.” with the program title written on the menu line.) You will be charged during the first day of each month. There is an Administration Fee of 5% for all payment plans, which is worked into the equal payment amounts. 1% interest on the current monthly balance owing will be added to your monthly payments up to a maximum amount of $50 per month. 8. You are responsible for paying all monthly payments, applicable taxes, interest charges, and administration fees for your programs and will be charged monthly whether you participate in the programs or not. There is no credit for missed programs. 9. A $35.00 administration fee will be charged to your account for each occurrence of: a) Cheques returned NSF; b) Denied credit card authorizations; and c) Late payments. 10. Should your account fall into arrears, you understand that your program registration will be suspended until all fees have been paid. If you neglect to make payments for a period of two months or more Full Circle Hypnosis Inc. has the right to demand that the unpaid principal, applicable taxes, interest, and administration fees become due and payment immediately. You will be required to pay all costs of enforcing payment, including but not limited to, legal costs. All business and agreements between you and Full Circle Hypnosis Inc. are governed by the laws of Alberta, Canada. Any disputes shall be resolved in Calgary, Alberta, Canada. 11. For those not using a payment plan, you must pre-register and pay for each course at least 90 days prior to the first day of each scheduled course. Late registrations and payments will be subject to a $20 late registration fee. If you are using a payment plan you must still register for each course at least 90 days prior or you will be subject to the late fee as well. 12. Many programs are email driven and therefore all participants must have an individual email address (not-shared). 13. Once your registration is in progress, you will not be able to pause or put your account on hold during any part of your payment schedule. All courses must be completed within two years of your date of registration. 14. Full Circle Hypnosis Inc. reserves the right to change, modify or cancel all programs, policies and provisions as necessary. 15. You agree to release Full Circle Hypnosis Inc., all its agents and staff from any personal, physical or financial liability incurred at, or as a result of, any programs. You understand that all action undertaken is performed voluntarily. CANCELLATION POLICY Full Circle Hypnosis Inc. provides quality programs. Each program requires extensive preparation based on the number of students. Activities and/or materials are pre-arranged at considerable cost to Full Circle Hypnosis Inc. We commit on your behalf. For the above reason our Cancellation Policy offers the following options: Coaching Programs & Individual Sessions All prepaid fees on individual or group coaching services are non-refundable. If you need to re-schedule an appointment you must provide at least 72 hours notice otherwise you will be charged the full session fee. Course Registration Due to administrative costs, salaries, coordination activities, materials printed, material acquisitions, hotel contracts and other business expenses incurred to produce a program, all registration fees are non-refundable. If a program is re-scheduled for any reason you will be automatically transferred into the next scheduled dates and notified of such. All scheduling changes must take place at least 90 days prior to the course date. There is a $25 rescheduling fee per course. Only one schedule change per course is permitted, and no change window is available on the revised course date. Course Dates Full Circle Hypnosis Inc. sells course registrations and does not guarantee course dates. All course dates are subject to change due to logistical factors such as attendance rate and venue availability. Course Accommodations All course pricing includes course tuition only. All food, travel and accommodation costs are not included in the course price. Products All products are non-refundable. Full Circle Hypnosis Inc. is committed to quality and will assist in replacing any defective product within the first 30 days of purchase. Thank you for taking an interest in our courses. We look forward to working with you soon!

I HAVE READ AND ACKNOWLEDGE The Terms & Conditions