Page 1 of 2
Hypnotherapy Enquiry Form
Please complete the form below so I can understand your needs and get in touch to arrange your introductory session.
*
*
*
*
What would you like support with?
*
(Please briefly describe the issue or goal you’d like to work on — e.g., anxiety, confidence, habits, sleep, etc).
Have you had hypnotherapy before?
*
A
Yes
B
No
Was your treatment successful?
How did you hear about me?
*
Instagram
Friend/Family recommendation
Other
Any additional info you'd like to share?
*
Consent, please read carefully and tick the below boxes
*
I understand that hypnotherapy is a complementary practice and not a substitute for professional medical or mental health treatment.
I consent to being contacted for the purposes of scheduling this session.
I understand my information will be kept confidential and used only for booking.
Submit
