Client History Form

Please ensure you complete & submit this form AT LEAST 24 HOURS prior to your scheduled 1:1 session to avoid a reschedule being required.

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1. Enter your personal details here: (Required.)

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2. Please describe the main issue/s you're experiencing & the specific EMOTIONS involved, using actual examples.

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3. How do you intend to feel about this by the end of your session? (Required.)

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4. Which parts of your life are most affected by this and what are your concerns if this is not addressed? (Required.)

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5. Your experience with hypnosis: (Required.)

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