eMail: Tel: 01462 626858 Mob: 07811 017374  
Hypnotherapy has been shown to provide effective and lasting changes with:
  • Anxiety/Depression
  • Fears/Phobias (Public Speaking, Flying, etc.)
  • Habits (Nail Biting, etc.)
  • Meditation
  • Pain Management
  • Panic Attacks
  • Performance Enhancement (Sport, Music, etc.)
  • Self Hypnosis
  • Sexual Problems
  • Smoking Cessation
  • Stress/Worry
  • Weight Control

Assessment Form

In order to be able to assist you as a client it is necessary for me to receive a fully completed Assessment Form from you.

A Rich text Format (.rtf type file) copy of my Assessment Form can be downloaded from this page (Click Here to Download).

This can be completed using any of the most popular wordprocessing software packages such as MS Word, Wordpad or OpenOffice.

Please be generous with your answers and where possible, avoid single word answers.

Upon completion this can be sent to me at
All therapy work requires full completion of an Assessment Form prior to booking a session (click here to download).

This can be completed and emailed to me at
© Simon Goodlad 2009