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New Client Details

  • Date Format: DD slash MM slash YYYY
  • Or, what you spend most of your time doing
  • Next of Kin

    Please provide details for an emergency contact that lives closest to you and whom you trust.
  • Health / GP details

  • Date Format: MM slash DD slash YYYY
  • (please list medications taken within the past 4 weeks).
  • (please list any significant medical procedures you've undergone).
  • Consent

  • Areas you're wanting help with:

    Please note that 'RTT' will focus on one area of change at a time - the minimum time between sessions is around 30 days. Coaching can be provided during this time if you feel you need additional support.
  • Also, If what you're wanting to achieve or overcome in your session isn't listed above, please note it here.
  • If you have tried hypnosis previously, how would you describe your experience?