Coaching Application

1 Step 1 - Personal Information

2 Step 2 - Your Concern

3 Step 3 - Before you send

Step 1 - Personal Information

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 *

Timezone *

Please briefly describe your main concern and what you hope to gain from coaching. 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. *

Minimum 50 characters

How long have you had this problem? *

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.

Evidence-based coaching with clinical hypnosis, donation-based · United Kingdom · worldwide

From the comfort of your home.

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