Free Discovery Call book a free chat Book M.U.S.C.L.E session Name * First Name Last Name Email * must be the client's active e-mail Subject * Message * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Birthday MM DD YYYY Phone (###) ### #### Please describe your ONE concern - the reason for your session * * i.e if I had a magic wand what is the ONE thing you want freedom from? What is your desired result/outcome for the session Marital status * Single Married Divorced Widowed Committed Relationship It's complicated Occupation Doctor's name, address & date of last check up, * Please list all medication and supplements being taken * If your issue is a physical illness or problem. Please explain and list your symptoms, doctor's recommendations/ prognosis and any info you think relevant Section Please select the areas that currently concern you from the list below: Achieving goals Addictions Anger Anxiety Career Childhood Problems Compulsive Behavior 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 Have you ever been diagnosed with a mental health condition? If yes please provide details below * Have you ever had a psychotic episode & or ever been prescribed antipsychotic medication? If yes please provide details below * 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 ever had Hypnosis before: * Never Once Several Times If yes, what for & how helpful was it? POST SESSION COMMITTMENT* I understand the importance of listening to my personalised recording daily, for at least 30 days to ensure optimum results I commit to listening to my recording CANCELLATION TERMS * All booked appointments require a nonrefundable $100 deposit. Any cancelations made with less than 24hrs notice are charged in full. These terms are created to ensure we value each other's precious time. I agree to the above cancelation terms Payment details will be forwarded on confirmation of your successful application. Sessions are $770AUD Price includes GST, your 90min-2hr personalised session, your personal recording & a 30min follow up/review consult 30 days after your session & of course your new freedom. Also, please note children are usually charged at a lower rate but vary case by case. If money is a barrier please request payment option here Thank you!