Coaching Application

1 Step 1 - Personal Information

2 Step 2 - Your Concern

3 Step 3 - Before you send

Step 1 - Personal Information

Coaching Application

Thank you for your interest in coaching. Please complete this application form to help me understand your situation and goals.

First Name *

Last Name *

Email Address *

Age Range *

Preferred Language *

Timezone *

Step 2 - Your Concern

How long have you had this problem? *

A few sentences will suffice. Please do not share any medical details or diagnoses here – we will discuss everything else in person during our initial consultation.

What do you hope to achieve from coaching? *

Minimum 50 characters

Step 3 - Before you send

I understand that this is a coaching service and not medical or psychological treatment.

I have read the privacy notice and consent to my details being stored in order to process my enquiry.

I treat every enquiry carefully and give each one proper time. I'm assuming you take it just as seriously – and if so, we'll get on well.

Evidenzbasiertes Hypno-Coaching auf Spendenbasis.

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This coaching is not a substitute for medical or therapeutic treatment.