Please note, this form needs to be completed 48 hours prior to the agreed session (unless we've agreed a session on short-notice).
Unclaimed sessions will be reallocated to customers on our waiting list.

For the following question, please take as long as you need and don’t worry if you can’t or don't want to answer some of them. Fill in as much or as little as you wish. All information is kept confidentially.

Please read our terms and conditions available here, as it contains important information regarding confidentiality, contra-indications and our cancellation/late attendance policy.

Reminder of Cancellation & Late Attendance policy:

  • Please give me as much notice as possible for the cancellation. For cancellations with less than 24 hours’ notice the full fee will be payable.
  • If you are late for your appointment we will still need to finish by the allotted time.
  • If you arrive for treatment under the influence of mind-altering drugs or alcohol, the session will be suspended, and the full fee charged. Further sessions will be at the therapist’s discretion and may be cancelled permanently.
  • If I think you would benefit from being referred to another therapist or specialist, we will agree to make the referral as soon as possible.
  • I reserve the right to cancel therapy at any time and to refuse prospective clients at my own discretion.

Note:
For Zoom sessions, all the relevant details to join will be emailed to you once this booking has been confirmed.
For face-to-face sessions, you will receive a link to a Covid19 form you will be required to fill in before the session.

Hypnotherapy Session: £80
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