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

Mind Detox

DeCode

Manifest Love

Quit Smoking

Alchohol Addiction

Other addictions: sugar, shopping etc

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

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