Stress and Anxiety 6 Month Online Group Programme Registration Form

Stress and Anxiety 6 Month Online Group Programme Registration Form
Thank you for registering your interest for our stress and anxiety online group programme. The monthly group sessions last approximately 1.5 hours and will be held on the following dates:

September:

4/9 Group Therapy Session 19:00 BST

23/9 Group Breathwork Session 18:00 BST

October:

9/10 Group Therapy Session 19:00 BST

28/10 Group Breathwork Session 18:00 GMT

November:

6/11 Group Therapy Session 19:00 GMT

25/11 Group Breathwork Session 18:00 GMT

December:

4/12 Group Therapy Session 19:00 GMT

23/12 Group Breathwork Session 18:00 GMT

January:

6/1 Group Therapy Session 19:00 GMT

27/1 Group Breathwork Session 18:00 GMT

February:

5/2 Group Therapy Session 18:00 GMT

24/2 Group Breathwork Session 19:00 GMT

If you are unable to make any of the sessions, you will have access to the recording of the live hypnosis or breathwork part of the session.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Please select if any of the following apply to you:*

Panic attacksHigh or low blood pressureEpilepsy or seizuresAsthma or any other respiratory conditionsStrokeHeart conditions or complications including coronary heart diseasePregnancyFaintingTinnitusKidney failureRaynaud's syndromeAny psychiatric condition such as schizophrenia or bipolar disorder or been hospitalised for an emotinoal disorder in recent yearsPTSDNone of the above
Please let me know your physical and mental medical history, diagnosis and any medication you are on:*
Please share information about what you are hoping to achieve through this programme:*
Where did you hear about this programme?*
Signature*

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