Please fill out the following information before we schedule an appointment or a call.
Date of Birth
GP name and address (it may be necessary to contact your GP before appointment)
Medical History (medications past and present, diagnoses past and present, etc), any heart or thyroid issues
No. of children and ages, if applicable
What is it you would like help with? Can you tell me a bit about how you feel?
What Therapy/ies are you enquiring about?
BWRT (BrainWorking Recursive Therapy)
What treatments / therapies have you tried in the past, if any? How helpful were they?
Where did you hear about my services?
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