Application for Coaching, RTT & Transformational Hypnotherapy with Charlotte Ferrier Name * First Name Last Name Email * Date & Time availability for discovery call and/or session * Please list preferred times & your availability so we can do our best to offer you a convenient time. Clinic or Online Session * All sessions can be booked either for face to face or online for your convenience. Online sessions are equally as effective as face to face. Please note Clinic Sessions are near Stroud, Gloucestershire. Clinic Online Session Time Zone if booking Online Session * Please list the town, state & country you'll be in for your online session... to ensure scheduling accuracy Phone Number I use whats app for international calls for initial chats so please include country codes. Marital Status * Single Married Divorced Committed Relationship It's Complicated Occupation * Doctor's name, address & date of last check up Please list all medications & supplements being taken * What are you looking to acheive through this process ? * Please give me some detail about what you want to change. What is the main thing holding you back ? * How much does the above hold you back on a scale of 1-10 ? * ( 1 being not at all + 10 Alot ) How committed to change are you on a scale of 1 - 10 ? 1 = Not very 10 = Absolutely Committed If your issue is a physical illness or problem. Please explain & list your symptoms and any triggers, doctors recommendations/prognosis & any info you feel relevant in as much detail as you can.. * How would you like to feel on a day to day basis. Please describe your ideal scenario in terms of how you feel in your mind and body If you were living the best version of your life, what activities and past times would you be doing that you are not doing or unable to do now? If you were free from this issue - what would this mean you could go on to do in the future? Give some examples of the kinds of things you say to yourself on a regular basis Please give a brief description of your family background Please select the areas that currently concern you from the list below: * Achieving goals Addictions Anger Anxiety Career Childhood Problems Compulsive Behaviour Concentration Confidence Depression Eating Problems Exams Fears Fertility Guilt Health Issues Memory Motivation Nerves Pain Control Panic Attacks Phobias Public Speaking Relationships Relaxation Self Esteem Sexual Problems Skin Problems Sleep Problems Stress Weight Problems Please add anything you feel is relevant in relation to the selections you've made or issues you struggle with... (even if not listed) Have you had hypnosis before: * Never Once Several Times If yes, what for & how helpful was it? How did you hear about Charlotte ? If referred pls let me know by whom... * POST SESSION COMMITMENT * I understand the importance of listening to my personalised recording daily, for at least 3 weeks to ensure optimum results I commit to listening to my recording. CANCELLATION TERMS * For sessions, full payment is payable on booking to confirm the session - non refundable within 30 days. (Please read T's & C's as appointments can be changed in serious circumstances) For personalised recordings - payment is due on ordering. I agree to the above cancellation terms Please indicate what service you are interested in, be it individual RTT sessions, coaching, a package ( see pricing page) or a personalised recording? I have read through and agree to the Terms & Conditions sent to me * I understand and agree Date of Birth Thank you!
