COMPLETE YOUR PAYMENT TO BEGIN YOUR PROGRAM

The goal at Clear Change Hypnosis is to provide you with the most effective process with the most efficient use of your time. The process begins with a systematic series of sessions that are customized for your unique needs, continued personal reinforcement, and self-hypnosis training. Many clients reach their goals in the initially scheduled sessions, and most people begin to experience benefits from the very first session. Many clients elect to schedule additional follow-up sessions for reinforcement coaching.

You have enrolled in the Quit Smoking for Life program, consisting of 1 private session per week for 3 weeks, and additional online support materials. This is an investment of $997 if paid in a single payment. There are several payment plans listed below for you to choose from (which include a convenience fee). If you opt-in to a payment plan, you agree that your card will be charged the amount you have chosen each month, automatically until your plan is complete. You will continue to have access to all support materials after your payment is complete.

By filling out this form and pressing the “Begin My Program” button below, you agree to the following:

• Fee Policy: I authorize Clear Change Hypnosis to charge me for the total above. I further affirm that the name and personal information provided on this form are true and correct. By pressing the order button below, I agree to pay Clear Change Hypnosis. I understand that this service is a packaged program. The charge will appear on my billing statement as Clear Change Hypnosis. No refunds will be issued.
• Payment Plan Policy: I agree and acknowledge that by choosing a payment plan, the debit/credit card that I provided will be billed in the amount specified starting today, and will continue on this day each month until payments are complete.
• Rescheduling Policy: I agree to attend all sessions and follow through to the completion of my program. If I cannot keep my scheduled appointment, I will give at least 24-hour notice of need to reschedule. At which time, my appointment will be rescheduled. If 24-hour rescheduling notice is not given, I understand that the scheduled appointment may be lost or considered a paid scheduled session.
• Lifetime Service Guarantee: I understand that I will have lifetime access (lifetime of the business) to the resources provided to me during this program. I agree to use the resources to the best of my ability to remain a non-smoker. If I need additional help, I can schedule followup hypnosis sessions to quit smoking up to once per month at no additional charge.
• Adult Learning Environment: I understand I am required to do the designated homework (listening to audios, practicing self-hypnosis and MindTools, discarding cigarettes, etc.) to help achieve the desired goal. I agree to show up to all scheduled sessions, listen to hypnosis audios, and apply what I've learned towards my goals.

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(Payment plans automatically withdraw on the same day each month.)