Please complete all sections before your first session.

Personal Details

Contact Information

Emergency Contact

Your GP

How Did You Hear About Greatest Mindset?

Relevant Context

Your Lifestyle medical history, and current health can affect how you respond to hypnotherapy. Stress, sleep, use of alcohol or substances, medicines and health conditions may influence the sessions' honest and accurate details, which help me work with you safely and effectively. Hypnotherapy is not a replacement for medical care, so please follow advice from your doctor where needed 

Lifestyle Behaviours

Substance Use

Exercise

Medical and Health Information

Please tick any that apply (Past or present)

Mental & Emotional Health

Neurological Conditions

Cardiovascular & Circulatory

Respiratory

Digestive & Gastrointestinal

Endocrine & Metabolic

Musculoskeletal & Pain

Immune & Autoimmune

Cancer History

Other