APPLY FOR CERTIFICATION

First Name

Last Name

Preferred phone

Which NBCCH-approved 50+ hour Clinical Hypnotherapy course did you complete?

When did you take your qualifying clinical hypnotherapy training?

Please provide ALL OF THESE: (1) State or Country (2) License type (3) License Number (4) AND EXPIRATION.

Malpractice policy information

Please check this box if you are a US Vet (active or honorably discharged) or if you work exclusively within the VA.

For which Certification level are you applying?

Certified Clinical Hypnotherapist (NBCCH)

Diplomate of Hypnotherapy (NBCDCH)

Fellow of Hypnotherapy (NBCFCH)

Certified Hypnotist (NBCHt)

Preferred email

Which suits your situation?

Just send me a PDF of my Certificate. I plan to file it.

Please send my frameable parchment and foil Certificate.

Certificates are included in your fee. PLEASE provide your name, credentials, AND compete mailing address (even if you requested the PDF).

I affirm that I have not been convicted of a felony, that the information I have provided is accurate, and that I will comply with NBCCH regulations.

SUCCESS...

YOUR FORM IS ON ITS WAY!

To complete your application now please go to the PAYMENT tab in the site menu.

(Veterans and full-time VA therapists are exempt from payment.)