Start Your Healing Journey!

Client Discovery & Session Intent Form

Name*

Email*

Phone*

Age*

Location*

What is your challenge/ challenges?*

Since how long have you felt like this?*

How does this affect your daily life?*

Interested in specific therapy?

1:1 Hypnotherapy

DeCode your life

Anxiety Release & Control

Narcissistic Abuse Recovery

Trauma Release & Recovery

Quit Smoking

Quit Alcohol

Become Free of other addictions

Mind Detox

Manifest Love

Nurturing Your Child's Subconscious

Consultation to find out whats best for me

Other

Your preferred days (at least 2 options)*

Your preferred time (at least 2 options)*

How ready are you to heal?*

Not sure

Kind of ready

Can't wait to start

bottom of page