Book a BQH Session with Sandra
Time for Completion: 15-20 minutes
Thank you for your interest in booking a healing hypnosis session. In order to assess whether this modality of hypnosis is a good fit for you, please complete the following questions, followed by the informed consent statements and signature field. All fields are required, it is a total of 17 questions, 8 information statements, and the payment processing form, please allow yourself plenty of time to answer the questions and process the payment.
Contact Info and Calendar Booking
Full Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Phone Number
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Email
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example@example.com
How did you hear about QuantumPath.community?
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Select your time for the BQH session:
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Questionaire
Please indicate how much you agree with the following statements, where the range is 1 strongly disagree, 2 somewhat disagree, 3 neutral, 4 somewhat agree, 5 strongly agree.
I feel motivated to address personal questions, patterns, or challenges in my life.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
I find it hard to trust others with personal matters.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What past life experience(s) have taught you about trusting others with personal matters
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I believe in a higher Power, God, or Universal Source of wisdom.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What are your thoughts on the idea of God, or a higher power
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I find it challenging to sit still without needing to control my thoughts or actions
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What types of stress management or relaxation practices have you tried, and for how long?
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I am comfortable with the idea of exploring memories, feelings, or past experiences in a relaxed state.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What was your experience growing up in regards to expressing the way you feel in an important or intense situation?
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I prefer to know exactly what will happen before I agree to something.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What are your feelings and mental state when unexpected things happen in your life?
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I am curious about exploring my inner world and understanding myself more deeply.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What are your thoughts on mental and emotional health therapy?
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I have trouble delegating tasks because I want to make sure they are done “my way"
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
Are you willing to work collaboratively and allow yourself to follow instructions during the hypnotherapy session?
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Yes
No
I believe that miracles or unexplained healing experiences are possible.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What are your beliefs in regards to the concept of the placebo effect, and of real life stories of people miraculously healing from a critical illness?
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I find it easy to relax and "just let go".
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
Are you willing to feel safe with the idea of temporarily letting go of control during the hypnosis session?
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Yes
No
I usually remember my dreams or can recall dreamlike images, and can visualize when I close my eyes.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
Are you able to describe the emotions and feelings your body experiences?
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I believe my mind has the ability to influence my physical and emotional well-being.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What are your beliefs about the concepts of 1. free will, 2. karma, 3. law of attraction?
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I am able and willing to remove any expectations I have about the results of a healing hypnosis session.
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Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
What are your expectations for the result or outcome of having a BQH session?
*
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Informed Consent and Liability Waiver
The purpose of this section is to provide information about the process of a Beyond Quantum Healing (BQH) session. By signing this consent, you acknowledge and agree that you have been informed about the session.
You acknowledge that Sandra Velandia, the BQH practitioner, is not a licensed medical doctor or psychotherapist and therefore cannot diagnose or treat any physical or mental disorders.
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You acknowledge that hypnosis does not intend to cure any medical condition, that it is not a form of therapy, and that the practitioner does not claim the session will cure any illness.
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You are willing to follow guided instructions of meditation, relaxation, and hypnosis, and are made aware that this practice is spiritual in nature and not medical, and it is your responsibility to inform your doctor of any changes in your condition or medication.
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You understand that this form of hypnosis is NOT a substitute for regular medical care, and have been advised to consult your doctor for any physical conditions, whether old or new.
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You understand that being in hypnosis does NOT mean being asleep. During a deep trance you may open your eyes, hold a conversation, laugh, and be aware of people and things around you. You may even believe you are not hypnotized. However, if you allow these thoughts to flow freely while the practitioner speaks to you, you will have a positive experience.
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You understand that change is entirely your responsibility. You understand that any act of healing is done by your Subconscious and that the practitioner is simply a facilitator guiding you through the process. It is your responsibility to be open and honest, and to provide detailed and accurate information that can help you achieve the best results.
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You understand that the session will be digitally recorded for your personal use after the session, and that Sandra Velandia retains the rights to these recordings. You also understand that with this type of metaphysical session, the energy in the room may affect the recording device and result in static or a blank recording.
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You understand that during hypnosis sessions, universal information may be received that could benefit humanity. You give permission to Sandra Velandia to share such information and stories in audio or video format through blogs or books, provided that your personal information is omitted.
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I am of legal age and understand that I am entering into a co-creative agreement using my free will. I agree to participate voluntarily in this session using hypnosis techniques and therefore release Sandra Johana Velandia from any claims, rights, demands, or actions that may arise from my participation. I have read and fully understood this Informed Consent And Liability Waiver.
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