Nidhin Wellness

Nidhin Wellness

RTT® Client Intake Form
Rapid Transformational Therapy

RTT® is a method developed by Marisa Peer, an award winning therapist from UK. It embraces many positive aspects of hypnosis, neurolinguistic programming, psychotherapy, psychology and cognitive behavioural therapy that are known to produce a transformative effects on clients.

Unlike many hypnotherapy treatments RTT® doesnot rely solely on positive reinforcement. RTT therapy gets to the root cause of an issue, giving the clients the most liberating understanding and transformative power to achieve dramatic long lasting results.

RTT® is endorsed by the National and International Council of Psychotherapists, The American Board of Hypnotherapy, The International Association of Complementary Therapists, plus the International Institute of Complementary Therapists.
EVERY DETAILS IN THIS FORM IS HIGHLY CONFIDENTIAL!
Name

First NameLast Name
Preferred Name
Age:
Mobile Number*

Country CodePhone Number
WhatsApp Number (if available)

Country CodePhone Number
Occupation
Email*
example@example.com
Confirm Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
AnxietyStressConfidenceProcrastinationMoney BlocksFinding Life PurposeFood/DietDrinkingSmokingDrugsGamblingCompulsive BehaviorFearsDepressionMotivationAchieving GoalsPhobiasPanic AttacksGuiltUnable to relaxEating ProblemsAnorexiaBulimiaExerciseCareer IssuesInterview SkillsNervesPublic SpeakingConcentrationExamsMemoryDriving SkillsSexual ProblemsFertilityIVFConceptionPregnancyBirthPain ControlHearingSight/visionMobilitySkin ProblemsHair GrowthRelationshipsChildhood ProblemsSleep ProblemsEmotional EatingOther
Out of all the above selected issues, what is the one issue that is affecting you the most?
Food
Brief Background of Current Concern:*
On a scale of 1 to 10, How commited are you to resolve this issue from your life?*
What you wish to gain from this session?*
Health Problems - Past & Present (if any):
Are you receiving any treatment from a Doctor (or) Other Practitioner?
Medications being taken (if any):
Are you comfortable in using Zoom application for the session?*
DISCLAIMER:

People with Epilepsy or any person diagnosed as having a psychotic illness should not enter hypnosis. Nidhin Muralidharan accepts no responsibility whatsoever. Under no circumstances including but not limited to negligence shall Nidhin Muralidharan be liable for any special or consequential damages in any way whatsoever now or in the future that results from the use of or the inability to use hypnosis, advanced hypnotic techniques, hypnotherapy or any other therapies. The information, techniques, methods and recommendations by Nidhin Muralidharan are not intended to substitute for the diagnosis and a care of a qualified doctor nor to encourage the treatment of illness by persons not recognisably qualified. If you use hypnosis and are under medical care for any condition, do not make any adjustments to any prescribed medication without approval of your doctor. If any doubt, you should seek medical advise.

Nidhin Muralidharan has taken due care and attention with the information provided at this therapy session and information is given in good faith. The information given is not intended to constitute medical advice. Always consult your GP before changing medications and evaluating treatment alternatives.

Nidhin Muralidharan does not accept responsibilty for any loss, damage or expenses resulting from the use of information provided. You agree to indemnify and hold us harmless by signing and agreeing to these conditions.

DECLARATION:

The information I have given here is to the best of my knowledge, full and correct. I undertake therapy on the understanding that it is a collaborative process, and that progress depends in part upon my own motivation and participation. I agree to be hypnotized by Nidhin Muralidharan . I agree to participate fully in the session. I grant permission to Nidhin Muralidharan to guide me and direct me by telling me to raise and drop my arms on my laps, rock my head, in order to facilitate the hypnosis deepening process.

I understand that having a recording made during part of my session and my willingness to listen to the recording for 21 Days will contribute to my success. I agree to listen to my personalized recording for 21 Days.
Signature*
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