{"id":2467,"date":"2026-03-11T13:48:05","date_gmt":"2026-03-11T13:48:05","guid":{"rendered":"https:\/\/lucidmindhypnotherapy.com\/?page_id=2467"},"modified":"2026-03-11T16:09:35","modified_gmt":"2026-03-11T16:09:35","slug":"intake-form","status":"publish","type":"page","link":"https:\/\/lucidmindhypnotherapy.com\/it\/intake-form\/","title":{"rendered":"Modulo d'ingresso"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2467\" class=\"elementor elementor-2467\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e25a9d3 e-flex e-con-boxed e-con e-parent\" data-id=\"e25a9d3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4ba35a8 elementor-widget elementor-widget-image\" data-id=\"4ba35a8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"420\" src=\"https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1-1024x538.png\" class=\"attachment-large size-large wp-image-1507\" alt=\"lucid mind hypnotherapy\" srcset=\"https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1-1024x538.png 1024w, https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1-600x315.png 600w, https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1-300x158.png 300w, https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1-768x403.png 768w, https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1-18x9.png 18w, https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1-800x420.png 800w, https:\/\/lucidmindhypnotherapy.com\/wp-content\/uploads\/2025\/11\/Untitled-design-1.png 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e048b58 e-flex e-con-boxed e-con e-parent\" data-id=\"e048b58\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4c5235f elementor-widget elementor-widget-spacer\" data-id=\"4c5235f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-70534f9 e-flex e-con-boxed e-con e-parent\" data-id=\"70534f9\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5c66047 elementor-widget elementor-widget-heading\" data-id=\"5c66047\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Client Intake and Agreement Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0d04b99 e-flex e-con-boxed e-con e-parent\" data-id=\"0d04b99\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-74446ea elementor-widget elementor-widget-text-editor\" data-id=\"74446ea\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\">Please complete this form before your session. All information is treated confidentially.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d366597 e-flex e-con-boxed e-con e-parent\" data-id=\"d366597\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7d33af0 elementor-widget elementor-widget-wpforms\" data-id=\"7d33af0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-2463\"><form id=\"wpforms-form-2463\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2463\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/it\/wp-json\/wp\/v2\/pages\/2467\" data-token=\"43b1a7fd5afe7dc2b42d497425c47d06\" data-token-time=\"1779789226\"><noscript class=\"wpforms-error-noscript\">Abilita JavaScript nel browser per completare questo modulo.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Abilita JavaScript nel browser per completare questo modulo.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-2463-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2463-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-2463-field_1-error\" required><label for=\"wpforms-2463-field_1\" class=\"wpforms-field-sublabel after\">Nome<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2463-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-2463-field_1-last-error\" required><label for=\"wpforms-2463-field_1-last\" class=\"wpforms-field-sublabel after\">Cognome<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-2463-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2463-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-2463-field_2-error\" required><\/div><div id=\"wpforms-2463-field_5-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_5\">Contact number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-2463-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" step=\"any\" aria-errormessage=\"wpforms-2463-field_5-error\" required><\/div><div id=\"wpforms-2463-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_3\">Emergency Contact Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2463-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-2463-field_3-error\" required><\/div>\t\t<div id=\"wpforms-2463-field_9-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"9\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-2463-field_9\" >like hear you<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-2463-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-2463-field_21-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_21\">Emergency Contact Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-2463-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" step=\"any\" aria-errormessage=\"wpforms-2463-field_21-error\" required><\/div><div id=\"wpforms-2463-field_4-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_4\">What would you like to achieve through these sessions?<\/label><textarea id=\"wpforms-2463-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-2463-field_4-error\" ><\/textarea><\/div><div id=\"wpforms-2463-field_11-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_11\">How did you hear about me?<\/label><textarea id=\"wpforms-2463-field_11\" class=\"wpforms-field-small\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-2463-field_11-error\" ><\/textarea><\/div><div id=\"wpforms-2463-field_16-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">Please indicate whether you have been diagnosed with, or currently experience, any of the following. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2463-field_16\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_1\" name=\"wpforms[fields][16][]\" value=\"Epilepsy or seizure disorders\" aria-errormessage=\"wpforms-2463-field_16_1-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_1\">Epilepsy or seizure disorders<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_2\" name=\"wpforms[fields][16][]\" value=\"Bipolar disorder\" aria-errormessage=\"wpforms-2463-field_16_2-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_2\">Bipolar disorder<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_3\" name=\"wpforms[fields][16][]\" value=\"Schizophrenia or psychotic disorders\" aria-errormessage=\"wpforms-2463-field_16_3-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_3\">Schizophrenia or psychotic disorders<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_4\" name=\"wpforms[fields][16][]\" value=\"Borderline personality disorder\" aria-errormessage=\"wpforms-2463-field_16_4-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_4\">Borderline personality disorder<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_5\" name=\"wpforms[fields][16][]\" value=\"Current psychiatric treatment\" aria-errormessage=\"wpforms-2463-field_16_5-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_5\">Current psychiatric treatment<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_6\" name=\"wpforms[fields][16][]\" value=\"Severe depression or suicidal ideation\" aria-errormessage=\"wpforms-2463-field_16_6-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_6\">Severe depression or suicidal ideation<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_7\" name=\"wpforms[fields][16][]\" value=\"Any other neurological condition\" aria-errormessage=\"wpforms-2463-field_16_7-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_7\">Any other neurological condition<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_8\" name=\"wpforms[fields][16][]\" value=\"Pregnancy\" aria-errormessage=\"wpforms-2463-field_16_8-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_8\">Pregnancy<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_16_9\" name=\"wpforms[fields][16][]\" value=\"None of these\" aria-errormessage=\"wpforms-2463-field_16_9-error\" aria-describedby=\"wpforms-2463-field_16-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_16_9\">None of these<\/label><\/li><\/ul><div id=\"wpforms-2463-field_16-description\" class=\"wpforms-field-description\">Please note that the presence of any of the above medical conditions may limit Giorgia Bettili's ability to offer hypnotherapy sessions.<\/div><\/fieldset><\/div><div id=\"wpforms-2463-field_17-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_17\">Current Medications<\/label><textarea id=\"wpforms-2463-field_17\" class=\"wpforms-field-small\" name=\"wpforms[fields][17]\" placeholder=\"Please list any medications you are currently taking (or write &#039;None&#039;)\" aria-errormessage=\"wpforms-2463-field_17-error\" ><\/textarea><\/div><div id=\"wpforms-2463-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Are you currently under the care of a GP\/doctor for mental health? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2463-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2463-field_18_1\" name=\"wpforms[fields][18]\" value=\"Yes\" aria-errormessage=\"wpforms-2463-field_18_1-error\" aria-describedby=\"wpforms-2463-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_18_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2463-field_18_2\" name=\"wpforms[fields][18]\" value=\"No\" aria-errormessage=\"wpforms-2463-field_18_2-error\" aria-describedby=\"wpforms-2463-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_18_2\">No<\/label><\/li><\/ul><div id=\"wpforms-2463-field_18-description\" class=\"wpforms-field-description\">If yes, please provide details below.<\/div><\/fieldset><\/div><div id=\"wpforms-2463-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2463-field_19\" aria-hidden=\"false\">If yes, please provide details:<\/label><input type=\"text\" id=\"wpforms-2463-field_19\" class=\"wpforms-field-large\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-2463-field_19-error\" ><\/div><div id=\"wpforms-2463-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_20\">Do you have any other medical, psychological, or neurological conditions that may affect your participation in hypnotherapy sessions? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-2463-field_20\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-2463-field_20-error\" aria-describedby=\"wpforms-2463-field_20-description\" required><\/textarea><div id=\"wpforms-2463-field_20-description\" class=\"wpforms-field-description\">Please provide details if applicable.<\/div><\/div><div id=\"wpforms-2463-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">My Health &amp; Fitness to Attend <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2463-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_8_1\" name=\"wpforms[fields][8][]\" value=\"By ticking the box below, I understand and agree to all of the following:\" aria-errormessage=\"wpforms-2463-field_8_1-error\" aria-describedby=\"wpforms-2463-field_8-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_8_1\">By ticking the box below, I understand and agree to all of the following:<\/label><\/li><\/ul><div id=\"wpforms-2463-field_8-description\" class=\"wpforms-field-description\">\u2013\tI am not physically or psychologically unfit to attend a hypnotherapy session.<br \/> \u2013\tI do not suffer from any undisclosed psychotic disorder.<br \/>\u2013\tI will attend each session with full capacity, under no recent use of alcohol or recreational drugs.<br \/>\u2013\tI understand that if Giorgia Bettili suspects recent alcohol or drug use, she may decline to proceed with the session.\n<\/div><\/fieldset><\/div><div id=\"wpforms-2463-field_23-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-2463-field_23\">Paragraph Text<\/label><textarea id=\"wpforms-2463-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-2463-field_23-error\" ><\/textarea><\/div><div id=\"wpforms-2463-field_6-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Privacy Notice, Data Consent &amp; Confidentiality <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2463-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_6_1\" name=\"wpforms[fields][6][]\" value=\"I have read and understood the Privacy Notice below, and I consent to Giorgia Bettili collecting, storing and processing my personal and health data as described below.\" aria-errormessage=\"wpforms-2463-field_6_1-error\" aria-describedby=\"wpforms-2463-field_6-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_6_1\">I have read and understood the Privacy Notice below, and I consent to Giorgia Bettili collecting, storing and processing my personal and health data as described below.<\/label><\/li><\/ul><div id=\"wpforms-2463-field_6-description\" class=\"wpforms-field-description wpforms-disclaimer-description\">Your personal and health data is collected solely to prepare for and conduct your hypnotherapy sessions. It is stored securely and will never be sold or shared with third parties without your explicit consent.<br \/><br \/>\nUnder UK GDPR, you have the right to:<br \/>\u2013\tAccess the personal data held about you<br \/>\u2013\tRequest corrections or updates<br \/>\u2013\tRequest deletion of your data at any time<br \/>\u2013\tLodge a complaint with the ICO (ico.org.uk)<br \/>Records are retained for 7 years in line with professional practice standards, then securely deleted. For the full Privacy Policy, please contact Giorgia Bettili directly.<br \/><br \/>\n\u2013\tAll content discussed in sessions will be kept strictly confidential by Giorgia Bettili. <br \/>\u2013\tConfidentiality may only be broken in the following circumstances: <br \/>(i) with my explicit written permission; <br \/>(ii) in cases of child abuse or safeguarding concerns; <br \/>(iii) where there is imminent risk of harm to myself or others; <br \/>(iv) if records are subpoenaed by a court of law.<br \/>\u2013\tIf my case is discussed with a professional consultant for supervision purposes, I will never be identified by name.<br \/>\n<br \/>\n<br \/>\n<\/div><\/fieldset><\/div><div id=\"wpforms-2463-field_7-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Client  Agreement <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2463-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_7_1\" name=\"wpforms[fields][7][]\" value=\"By ticking this box, I confirm that I understand and agree to all of the following:\" aria-errormessage=\"wpforms-2463-field_7_1-error\" aria-describedby=\"wpforms-2463-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_7_1\">By ticking this box, I confirm that I understand and agree to all of the following:<\/label><\/li><\/ul><div id=\"wpforms-2463-field_7-description\" class=\"wpforms-field-description wpforms-disclaimer-description\">\u2013\tHypnotherapy is not a replacement for medical, psychological, psychiatric or counselling services.<br \/>\u2013\tGiorgia Bettili does not treat, diagnose, or prescribe for any medical or psychological condition.<br \/>\u2013\tResults from hypnotherapy vary on a case-by-case basis and cannot be guaranteed.<br \/>\u2013\tI am free to terminate any session at any time, in observance of the cancellation policy.<br \/>\u2013\tFull payment is required upon booking, prior to the session.<br \/>\u2013\tA 48-hour cancellation policy applies. Cancellations made within 48 hours of the scheduled session will be charged in full.<br \/>\n<br \/>\n<\/div><\/fieldset><\/div><div id=\"wpforms-2463-field_12-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Stay in touch (optional)<\/legend><ul id=\"wpforms-2463-field_12\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_12_1\" name=\"wpforms[fields][12][]\" value=\"I would like to receive occasional news, events, courses and exclusive offers from Lucid Mind Hypnotherapy by email. I understand I can unsubscribe at any time and my data will be processed in accordance with the Privacy Notice above.\" aria-errormessage=\"wpforms-2463-field_12_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_12_1\">I would like to receive occasional news, events, courses and exclusive offers from Lucid Mind Hypnotherapy by email. I understand I can unsubscribe at any time and my data will be processed in accordance with the Privacy Notice above.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2463-field_10-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Declaration &amp; Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2463-field_10\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2463-field_10_1\" name=\"wpforms[fields][10][]\" value=\"I hereby give my full and informed consent to receive hypnotherapy sessions with Giorgia Bettili. I have accurately and truthfully provided all personal information requested in this form. I confirm I have read and understood all sections of this form and I agree to the terms set out above.\" aria-errormessage=\"wpforms-2463-field_10_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2463-field_10_1\">I hereby give my full and informed consent to receive hypnotherapy sessions with Giorgia Bettili. I have accurately and truthfully provided all personal information requested in this form. 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