• Client Intake Form (approx 15 min to complete)

    Complete and return at least 2 days before your appointment. Completed forms are encrypted for your privacy and protection, however, only complete what you're comfortable with. We can go through the blanks when we meet.

  • Health Check

  •

  • Lifestyle Check

  • Wellness Check

  • Assess each point by rating your satisfaction on a scale of 1 to 10. 1 being room for improvement, and 10 being the most content.

    This will help us work on goal setting and points of focus.

    Remember - there's no right or wrong answer. You can interpret these points any way you choose

  •

  • How did you find out about us?

  • Confidentiality and Consent

  • CONFIDENTIALITY

    Your sessions with me are all completely confidential.

    There are situations where, if they present, I will be required to break that confidentiality.

    You need to be aware of these instances and acknowledge that you are aware of this.

    Instances where confidentiality will need to be broken:

    • There is the possibility of harm to yourself and/or others
    • I am required by law (subpoena or for mandatory reporting)
    • For purposes of referral and/or supervision

  • N.B. Health fund rebates vary between funds and levels of cover. Additionally, changes in policy can occur at any time. We cannot tell you if your particular insurance policy will cover your hypnotherapy sessions, or what your rebate will be.

  •  - -
  • Should be Empty: