Client Information Form

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Please complete this form as fully as possible. The information you provide will be used to prepare for your first appointment. When you submit this form, the information will be sent directly to my email inbox and will only be seen by me. 

Any information you provide will be kept confidential in accordance with the terms of the Client Agreement, which can be viewed here.

Hypnotherapy, NLP and Talking Therapies have a good track record in helping people to make lasting changes, however everyone responds differently and therefore results may vary from person to person. Your motivation and participation are the key to success, so you need to play your part too.