Application Form

Name

First Name

Last Name

Phone

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How did you Find Me?

What Specific Problem Are You Seeking to Solve with my Help?

Have you Done Hypnotherapy Before?

Yes

What challenges or struggles have been weighing on you the most lately?

How are these showing up in your daily life — in the way you feel, think, and interact with others?

How long have you been living with these challenges?

What have you already tried to change this… and how well did it work?

Imagine 90 days from now — you’ve made the changes you came here for. What’s different in your life?

How would it feel to wake up living that reality each day?

Who else in your life would notice and benefit from this change?

On a scale from 1–10, how ready are you to make these changes now?

Why do you feel now is the right time to do this work?

Are you willing to invest the time, energy, and resources necessary to create this transformation?

My Session/Program isn't cheap. Expect to pay around $500-$1,500.

Yes

As you think about taking this step, what’s the most important thing you want me to understand about you, your journey, or your goals?

✅ Application Received — You Just Took the First Step