Jessica Petter, CH State Registration Code: HP61174361 By law I am required to disclose certain information to my clients. This is for your protection. In my Performance Mindset Program, I use and teach clients sports visualization and a light form of hypnosis. I graduated from Cascade Hypnosis Center in Bellingham, WA in 2021 and the Attitude of a Champion Sports Hypnosis program in 2025. I am a registered and Certified Hypnotherapist, a Certified 5-PATH Hypnotherapist, and a member of the National Guild of Hypnotists. Fees are $800 for the 4-Session Peak Performance Program and $200 per session for additional sessions. Please allow 48 hours' notice to reschedule or cancel any appointment. A $50 fee will apply to repeated late cancellations. The session is confidential, this is your right by law, unless: • You have given written consent stating otherwise. • You confess a major crime or felony (no one can make you divulge secrets under hypnosis). • You are a minor, and there is physical evidence of abuse. • There is a subpoena for court relating to this session. • Or if there were charges brought against me for unprofessional conduct as described in the Washington State Uniform Disciplinary Code. All hypnotic portions of sessions at Shift Hypnosis are audio recorded and kept as part of your confidential record. If you have experienced unprofessional treatment by a hypnotherapist or health care professional, you may report it to: Dept. of Health P.O. Box 477869 Olympia, WA 98504-7869 Acknowledgment & Consent I understand that all hypnosis is self-hypnosis. I voluntarily consent to hypnotherapy with Jessica Petter, CH, acknowledging that there are no guarantees of specific results. I take full responsibility for my participation. I am signing this before being hypnotized. I understand that Shift Hypnosis, LLC workshops, lectures, materials, and sessions offer opportunities for personal growth. Any guidance provided is for informational purposes, and I will follow it at my own discretion. Hypnotherapy does not replace medical treatment. I will address medical health concerns with the appropriate professional. By typing my name below, I acknowledge that I have read, and I understand this disclosure. I have read and understand my rights. (Parent/Guardian Name or Athlete's name if not a minor)