First Name

Last Name

Email Address

Trusted Friend's Mobile Number & Country Code

Why you need this session? Please provide 4 questions that you want to ask your Higher Self or Subconscious during our session. Eg: Why am I stuck with my life? What is my life's purpose? Am I following my soul's purpose? I want to quit my job, how can I transition?

Have you had Past Life Regression before? Yes/No Have you had Past Life Regression before? Yes/NoYesNo

Safety and Technology Requirements: Safety and Technology Requirements: I confirm that the session is online and not face to face. I confirm that I have a strong internet connection and a built-in or external camera on my device for video calling (ideally laptop or desktop). I confirm that I have a decent microphone and headphones to communicate and hear the session clearly respectively. I confirm that I will be alone in a quiet, comfortable space where I can lie down or sit on a reclining chair during my session while still able to hear clearly using headphones and microphone. I understand that in the event of an unexpected internet or power disconnection, my mind will naturally and safely transition out of trance back to full awareness. I confirm my emergency contact is present on the same property (but not in the same room) solely as a safety contact in case of a technical drop or physical emergency, and will not participate in or manage the hypnosis process.

Session Length: Session Length: I am aware that the session can take at least 3-4 hours.

Age and Diagnoses: Age and Diagnoses: I confirm that I am at least 18 years of age. I explicitly confirm that I have NOT been diagnosed with, nor am I currently suffering from or receiving treatment for: Psychosis, Schizophrenia, Bipolar Disorder, Dissociative Identity Disorder, Severe Clinical Depression, Uncontrolled Epilepsy/Seizures, or Advanced Cognitive Impairment. I understand that the Practitioner is NOT a licensed medical doctor, psychiatrist, psychologist, or clinical hypnotherapist, and that this session does NOT constitute medical or psychological diagnosis, treatment, or therapy.

Terms and Conditions and Privacy Policy: Terms and Conditions and Privacy Policy: I agree and understand the Terms and Conditions and Privacy Policy. I agree to fully release and hold harmless, Flora Mae Stafford and Growth Teacher from and against any all and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

Filming, Recording & Promotional Usage Consent - I expressly agree and consent to the following terms: Filming, Recording & Promotional Usage Consent - I expressly agree and consent to the following terms: 1. Consideration: In exchange for receiving these services free of charge, I expressly consent to being recorded (audio/video) during the session and grant Flora Mae Stafford and Growth Teacher the non-exclusive, worldwide rights to use, edit, and distribute footage for educational and promotional purposes. 2. Identity Protection Options: I understand Flora Mae Stafford and Growth Teacher agree that no Personally Identifiable Information (PII) (such as my full legal name, contact details, home address, or sensitive operational data) will ever be disclosed or published. Prior to recording or publication, I may elect any of the following privacy measures by written notice: a.) Visual Obfuscation: Blurring or masking of my face/visual identifiers. b.) Audio Modification: Voice masking/pitch shifting. c.) Pseudonymity: Use of a first-name-only designation or an assigned pseudonym. 3. Irrevocability: I acknowledge that because the recording forms the sole material consideration for receiving this free session, my consent to record under the protection parameters elected above cannot be revoked post-session.

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Name of Your Trusted Friend or Companion

Disclaimer: Disclaimer: I understand and agree that Past Life Regression and self-hypnosis are spiritual and self-development tools, not substitutes for professional medical or mental health care, and that no specific outcome or 'healing' is guaranteed.