Music and Lyric Event Registration: Please call or text Dr. Wendy at 760-994-9296.

New One-on-One Clients: Please complete the registration form below. Once submitted, your information will be sent directly to Wendy Hill, Ph.D. Then, complete your Meyers Briggs Personality Test.

Full Name *

Age *

Birth Date (MM/DD/YYYY) *

Marital Status *

Cell Phone *

Other Phone (Home/Work)

Home Address *

Street, City, State, and Zip

Email *

Occupation & Employer

Occupation, Employer, and Employer Address (optional)

Spouse/Mate Information

Name, Age, Occupation, and Phone (optional)

Emergency Contact Name & Phone Number *

Children (Names & Ages)

Optional

Referred By

Agreement serves Name

Payment, Refund, and Cancellation Policy *

I have read and agree to the Payment, Refund, and Cancellation Policy

Full policy text: https://wendyhill.com/registration-policies-agreements/

Non-Profit Status & Insurance *

I understand that CentrePoint, Inc. is a non-profit organization and that insurance will not cover services.

Emotional Release & Hypnosis Risk Acknowledgment *

I understand that hypnosis, guided relaxation, age regression, and related therapeutic techniques may bring up strong emotions, memories, or physical sensations, and I consent to participate in these methods as part of my treatment.

Full policy text: https://wendyhill.com/registration-policies-agreements/

Medical Conditions & Medications *

Please list any medical conditions you have been diagnosed with, any medications you currently take (prescription or over-the-counter), and the name of your treating physician, if applicable. If none, please write "None."

Session Description & Cancellation Agreement *

I understand that sessions may include history-taking, guided relaxation, hypnosis, and emotional release, and I agree to the 48-hour cancellation policy (sessions cancelled with less than 48 hours' notice may be charged in full).

Therapist-Client Arbitration Agreement *

I have read and agree to the Therapist-Client Arbitration Agreement.

Full policy text: https://wendyhill.com/registration-policies-agreements/

Type Your Full Legal Name (this serves as your signature) *

Signature Confirmation *

I confirm that the name entered above is my true legal name, and that submitting this form constitutes my electronic signature and agreement to everything acknowledged above.

Take the Personality Test