Please fill out this form for your free initial consultation on dealing with unresolved issues.
Once I have received your email, I will e-mail you back with a few times I have available which you can chose from for your initial consultation.
First Name: Last Name: Email: Age: Sex: Male Female Times you are available for an appointment?
First Name: Last Name: Email: Age: Sex: Male Female How long have you been suffering from unresolved issues? less than a year 1-2 years 2-5 years 5-10 years Over 10 years Is there any particular time when you feel that unresolved issues effect you most? Yes No If yes to above please give details Is there any particular situation that you feel that unresolved issues affect you most Yes No If yes to above please give details How often would you say you suffer from the effects of unresolved issues? Occassionally Frequently All the time Do you suffer from any allergies Yes No Are you taking any mind altering medication? Yes No Please tell me in your own words and as much detail as possible about your unresolved issues. Including anything you may think is relevant no matter how silly it may sound
Copyright © 2007 Henry Marshall D.H.C.P. M.E.A.C.H. Hypnosis therapy and psychotherapist. Grantham Lincolnshire | Sitemap Useful links