First name *

Last name *

Address *

Email *

Phone *

Date of birth *

Please provide a brief description of how I can help

Please select any that are applicable to you
Experience IBSGet MigrainesBite NailsIrrational Fears / PhobiasConcerns about alcohol / drug use

Sleep Issues?
Trouble getting to sleepWake up during the nightWake up too earlysluggish in the morning

Have you read my GDPR notice? *
YesNo

View the GDPR Policy.

Doctor’s practice *

Do I have permission to contact your GP? *
YesNo

I hereby consent to receive Solution Focused Hypnotherapy from Glen Charles