PSYCH-K® 1-1 Session Intake Form Name* Your Email* Phone Number* How did you hear about PSYCH-K®? DisclaimerI understand that the PSYCH-K process is strictly limited to the modification of beliefs and is not designed to diagnose medical problems, nor is it a replacement for medical attention or professional mental health care. I also understand that, while the PSYCH-K® process can help modify personal limiting beliefs and perceptions around health, it does not heal or cure conditions. I understand that I have not been given any guarantees or promises regarding the outcome of my PSYCH-K® session and that, while Cynthia Mitchell can help me identify and change subconscious beliefs, the outcome and results may be dependant on my action steps and I understand that it may take more than one session to transform my current experience fully.Signature*Please type your name to confirm you have understood the disclaimer NameThis field is for validation purposes and should be left unchanged. Δ