Please try to answer as many questions as possible, it is fine if you can't or don't want to answer some of the questions, 

I know there is a lot to answer but this will help me to help you get the most out of our Therapy Sessions.

Questions 1 to 7 are about your Personal Details. These details are needed so i can contact you and know who I'm working with.

Questions 8 to 17 is about your Medical history. This section is needed so i can determine if you are suitable for Hypnotherapy or if i need to recommend a referral to a different specialist, also in the event of a medical emergency i may need to contact your GP or psychiatrist.

Questions 18 to 29 are about your likes and dislikes. It is helpful to know, so that i can write your scripts to give you best outcome and results from your sessions. 

If there are any mandatory questions you don't know or are unsure how to answer then just enter N/A in the box.

If you happen to run out of space or have additional information to tell me, then please enter into the message box below.