Hypnotherapy
Life coaching
Services
Contact
FaQ
Eng

Hypnotherapy
Life Coaching
Services
FaQ
Contact

Congratulations!

Your application has been successfully paid. Please, check your email for your receipt.

IMPORTANT: Please, choose between the options according to the product you acquired:

FOR RTT

(if you acquired an RTT session or a package with RTT)
FOR COACHING
(if you acquired one or more coaching sessions)
and fill out the form below.
After this, you will be contacted to make an appointment.

ПОЗДРАВЛЯЕМ!
Ваша заявка успешно оплачена. Проверьте ваш имейл для подтверждения.
ВАЖНО: Пожалуйста, выберите поле КОНСУЛЬТАЦИЯ ДЛЯ ТРАНСГЕНДЕРНЫХ ЛЮДЕЙ и заполните анкету ниже. После этого мы назначим дату и время для консультации.

Intake Form for Coaching Sessions

Part 1: Your contact information

*required fields

Name*

Email*

WhatsApp or Telegram number*

Choose the number of coaching sessions you acquired*

Part 2: Your personal information

*required fields

Age*

Preferred pronouns?

Part 3: Your expectations

*required fields

What are your expectations from coaching?*

Any other information you feel may be important for the session

Have you ever had coaching before?

yes

How did you find me?*

I am of legal age, have read and agree to the Waver Document (including the mandatory cancellation within 48 hours and no refund policy section) and Privacy Policy.

Анкета для консультации для трансгендерных людей и их близких

*обязательно для заполнения

Имя*

Email*

Номер телефона для Телеграм или WhatsApp*

Возраст*

Предпочтительное местоимение

Тема для консультации*

Я совершеннолетний_яя, прочитал_a и согласен_снa c политикой конфиденциальности.

Intake Form for RTT Sessions

Part 1: Your contact information

*required fields

Name*

Email*

WhatsApp or Telegram Nr.*

Choose the product you acquired*

Part 2: Your personal information

*required fields

Age*

Preferred pronouns?

Part 3: Your health information

Health problems

current and past

Current medication

From the list below mark the areas that concern you

Addictions
AD(H)D
Alcohol
Aggression
Anorexia
Anxiety
Apathy
Astma
Bulimia, Binge eating
Bipolar disorder
Borderline personality disorder
Boundaries
Burn-out
Career Issues
Childhood (problems from your childhood)
Children (problems with your children)
Chronic fatigue
Co-dependency
Concentration and focus
Confidence
Control issues
Depression
Drugs
Eating disorders
Eating and diet (in general)
Emotional management
Epilepsy
Erectile dysfunction
Exams
Exercise
Fertility
Gambling
Gender identity
Guilt
Hair growth
Hallucinations
Headaches
Interview skills
Insomnia
Imposture syndrome
IVF
Memory
Motivation
Nail-biting
Nervousness
Obsessive compulsive disorder (OCD)
Orgasmic dysfunction
Overweight
Pain (in general)
Pain during sex
Panic attacks
People pleasing
Phobias
Pregnancy
Procrastination
PTSD
Public speaking
Relationships
Relaxation
Schizophrenia
Self-esteem
Sexual orientation
Sexual problems
Shame
Skin problems
Sleep problems (in general)
Smoking
Social anxiety
Somatoform disorder
Sports performance
Speech impediment
Stage fright
Stress
Suicidal
Unhealthy lifestyle

Other area of concern, not listed above

please specify

Part 4: Your expectations

*required fields

What would you like to work on during this session?*

Describe briefly what would your life look like without the problem?

What are you most proud of in your life?

Any other information you feel may be important for the session

Have you been hypnotized before?

yes

How did you find me?*

I am of legal age, have read and agree to the Waver Document (including the Cancellation and Refunds section) and Privacy Policy.

I confirm that to my knowledge I do not have any of the following disorders: epilepsy, multiple personality disorder, schizophrenia, psychosis and do not have any psychotic symptoms, such as hallucinations.

Contact me

You can contact me through the form below.

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