Please fill out this form for your free initial consultation on weight loss.
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 What is your weight now? How much weight would you like to lose? Is there any particular time when you feel that it is harder for you to lose weight? Yes No If yes to above please give details Is there any particular situation that makes it harder for you to lose weight? Yes No If yes to above please give details 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 the problems you have losing weight. 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