Weight Loss Wednesdays

Join our Weight Loss Wednesdays (by Zoom). Embracing 2025 and creating the body that you want and deserve by offloading emotional baggage, creating healthier coping strategies, enjoying your food and recognising when you are full.

Starting Wednesday 26th February, 8-9pm for 4 weeks, for just £125.

You will also receive a downloadable version of ‘Relaxing and letting go of worries’ audio recording.

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Your name

First Surname

Your address*

Street Address Address Line 2 Town or City Postcode Country

Your email address*

Your telephone number*

Your date of birth*

Your occupation*

Next of Kin - Name*

(Required for insurance purposes)

Next of Kin - Telephone*

(Required for insurance purposes)

GP Surgery - Name*

(Required for insurance purposes)

GP Surgery - Telephone*

(Required for insurance purposes)

Do you have any medical conditions?*

Yes

Medical conditions*

Please provide details of your medical conditions.

Have you ever experienced depression, schizophrenia, epilepsy or bipolar?*

Yes

Details of depression, schizophrenia, epilepsy or bipolar*

Please provide details of your depression, schizophrenia, epilepsy or bipolar.

Your current weight*

Your goal weight*

How many hours do you sleep (uninterrupted) per night?*

What is your alcohol consumption per week?*

Do you smoke?

Yes

How many caffeinated drinks do you consume per day?*

Do you take any non prescribed drugs?

Yes

Comments

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Terms and Conditions of therapy:

Clients should join the Zoom link punctually. Please note that the session will start promptly so it is advisable to connect beforehand. Lateness to a session may mean that you are unable to join that session.
Information shared by the client is treated in strict confidence. However, if there is deemed to be a serious risk to either the client or anyone else then information may be disclosed appropriately. In this event the client will be advised accordingly.
In accordance with the General Data Protection Regulations (GDPR) client records are maintained and stored securely for 8 years after which they will be destroyed by shredding.
To ensure the safety of both the client and the hypnotherapist sessions are recorded and all recordings will be treated confidentially.
Clients must not attend any therapy session under the influence of either alcohol or drugs.
As a professional therapist professional development is regularly undertaken. This may include sharing client experiences and results (on an anonymous basis) with peers and supervisor(s). If you would prefer not to be included please inform your hypnotherapist by ticking this box.
The session prices are as stated on the website. Payment is taken at the start of each block of sessions.
Clients must take responsibility.
Refunds are not given where package sessions are not attended.
The therapist reserves the right to discontinue sessions at any time if she feels uncomfortable for whatever reason or feels that the client is not taking sufficient responsibility for making changes themselves.

Terms and Conditions*

I accept the Terms and Conditions of therapy above

Payment by PayPal

Clicking the submit button below will direct you to PayPal to securely pay for the booking. Please note that the booking won't be submitted to us unless the PayPal payment is made.

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