Please use the form below to get in touch, we would love to hear from you and will do our best to help.

Intake Form

Please complete this form to help us create the best sessions for you. All your information is confidential and will not be shared with other parties.

Would you like sessions
in a language other than English, if yes which language?
Enter language?
Any trigger warnings we should be aware of? (for example
fears, phobias, traumatic events)
Have you had hypnosis, hypnotherapy or regression therapy
before, either 1 on 1 or in a group?
X
How did you hear about us?
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