Please fill out the form, in full, before we schedule an appointment or a call. Incomplete forms may not be accepted. Over 18s only.
Date of Birth
Medical History (medications past and present, diagnoses past and present, etc), any heart or thyroid issues
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?
Should be Empty: