Registration process

Client Agreement

By submitting this registration request you will be agreeing that you have read and understood our Client Agreement. CLIENT AGREEMENT
The client agreement forms the basis of our working together for the initial consultation (which will provide the foundation we will work from) before moving on to our formal Hypnotherapy sessions which are also covered.

GDPR (Data Protection)

Read about our commitment to protecting your personal data and information in GDPR compliance GDPR PDF
N.B.the only personal data we store online is your name and email and this is well protected (only used to confirm you are registered for bookings).
Other details and information such as those in the client agreement are stored securely offline.

Information Gathering

First Name

Surname

Date of Birth

Phone

Address

Post Code

Occupation

In an ongoing relationship

Any Dependants

Partner Name

Dependants Names

How are we going to help you ?

If you considered our work together to be a success, what would you have achieved?

Signs or common symptoms of anxiety.
Do you:

A Yes or NO response is required for each question so that I have a complete overview of issues which may impact on the key one you are seeking to address

Experience IBS

Get Migraines?

ReCheck Things?

Bite Nails?

Have concerns about alcohol use?

Have concerns about smoking?

Have concerns about drug use (recreational or other )?

Have any irrational fears or phobias?

Have you ever had a panic attack (fast heartbeat, hot/cold flushes/ fast breathing?)

Have difficulty getting to sleep?

Wake up during the night?

Wake up too early?

Are you sluggish in the morning?

Are you on any medication?

Medical

Do you consent to me speaking to your GP if necessary?
Depending upon your responses, if we do not have consent it may not be able to provide sessions

GP Practice

Any other important medical or other information we need to be aware of ? - if none then please type NONE

Consent / Confirmation of Details

In submitting this digital registration you are electronically confirming

agreement to our Client Agreement
consent to participate in Hypnotherapy
verification that you are aware of our GDPR Policy
your details (and their accuracy)