Breakthrough Session Application Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Date of birth (DD/MM/YY)Leave blank if you don't wish me to look into your Human Design chartTime of birth (AM/PM)Leave blank if you don't wish me to look into your Human Design chartPlace of birth (city+state+country)Leave blank if you don't wish me to look into your Human Design chartName & email of the person who recommended my services to you (if applicable)1. What is one specific issue that, if it was resolved, would bring the most positive change into your life?2. Describe the issue with all the details that you judge important: When and where did it start? Do you know what created it? How does it show up in your life, daily life? etc…3. How is it a problem for you?4. Have you ever tried to work on this issue before? If yes, describe what you have tried (therapy, coaching, books, personal research etc…) What results (if any) did you get?5. What would you lose if the problem was solved?6. What would you gain if the problem was solved?7. Are you currently doing therapy, coaching or counselling sessions with another practitioner?8. Have you ever received a mental health diagnosis from a professional? If yes, please list everything here. (No judgment, this is just for your own safety as some of the tools I use - like hypnosis - are not recommended with certain diagnosis)9. Are you ready to take full responsibility for your life and your results?10. Do you have any concerns or fears about working with NLP, hypnosis or being put in a trance state? Submit ** All of the information provided in this form will remain strictly confidential.
