Appointment Form — Heid Hypnotherapy

Consultation form

Name

First Name

Last Name

Describe why you are seeking hypnotherapy?

What have you tried already?

Have you had hypnotherapy before? What was your experience?

What other therapies have you had? What was your experience?

What do you believe your experience will be with Heid Hypnotherapy?

Describe your favourite place

Tell me in as much descriptive detail as possible about a happy memory

What will your life be like when you have met your hypnotherapy goals?

Are there any other needs you might seek hypnotherapy for in the future?

Consent to hold information for treatment reasons

Yes

If you prefer to skip the free online consultation and longer introductory session, please fill out this extended consultation form.

You are also welcome to fill this out if you’d like to give me more information.

A word version of this form is available from katiegerrard@heidhypnotherapy.com

Permission to store information related to yourself and your treatment allows me to make notes which helps me plan each session. It will be held according to GDPR regulations.