1PERSONAL INFORMATION2BOOKING CONSULTATION3REASON OF YOUR CONSULTATION Gender SelectMr.Mrs.Other Type ypur specific gender First Name Phone Date of birthday Last Name Marital status SelectSingleMarriedDivorced Email Next Free consultation 30 minutesYou are booking appointment in timezone: US/Eastern Select a date Select a time 10:00 AM 12:00 PM 2:00 PM Previous Next Reason for seeking hypnotherapy: Currently seeking help for this issue? SelectMedicalProfessionalMedical and professionalNo, this my first Why? Where? When? Why is this Goal important to you? Are there any obstacles or blocks that are preventing you from achieving your goal? Is there anything you would like me to know ? please tell me a little bit about your self Any previous attempts to address this issue? Is this your first time being hypnotized? SelectYes, this is my first timeNo, i am a regular when was your previous experience(s), Do you feel it was successful? What is your Goal with this Hypnotherapy Session? What will your life look like or how will you feel when you accomplish this goal? Please list any medical and/or emotional conditions or history, and medications: Any specific fears and/or phobias? (EX. water, heights, snakes, etc.) IMPORTANT TO READ I consent to participate in the process of hypnosis with immortality healing. I understand hypnosis can involve the use of techniques such as progressive relaxation, guided imagery, meditation as well as other helpful techniques. As a part of hypnosis, clients are encouraged to go into a trance to better assist the removal of habits that no longer serve them. I understand that hypnosis is not a replacement for medical treatment, I understand that Giovanny Gustave does not treat or diagnose any condition. I understand that Giovanny Gustave is a facilitator of hypnosisspiritual coach alternative practitioner. I have read and understand the above consent of liability agreement, by my signature I consent to this agreement. I consent to participate Previous Submit The form was sent successfully.An error occured.
