Past Life Regression Client In-Take Form

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By submitting this form you agree to the information below.

I realise that Jaco Pieterse is a hypnotist and not a medical doctor or psychologist, and that he cannot diagnose disease, prescribe, or treat medical conditions or serious disorders. I understand that the past life experience might be information from the subconscious mind which is presented as a metaphor, not unlike the process of dreaming. Additionally, I should continue any present medical treatment and consult my regular physician for treatment of any new or old illnesses. I also agree that Jaco Pieterse or myself may terminate this relationship at any time for any reason whatever.