Book Your Free 30-Minute Consultation

Fill out the form below and I will be in touch to schedule your free consultation. This helps me understand what you are dealing with so we can make the most of our time together.

About You

Personal Information

First Name

Last Name

Preferred Name (if different)

Phone/WhatsApp

Where are you based?

What Brings You Here

The Issue You Would Like to Address

In your own words, what is the primary issue or challenge you would like to work on?

There are no wrong answers. Just describe what is going on for you right now.

I am not entirely sure yet. I would like to discuss and clarify together.

Areas of Concern

Check any that apply

Select everything that feels relevant, even if it is not your primary focus. This helps me see the full picture.

Addictions Anxiety Eating Problems Depression Drinking Stress Weight Problems Confidence Smoking Fears Anorexia Self-Esteem Drugs Phobias Bulimia Motivation Gambling Panic Attacks Exercise Achieving Goals Compulsive Behavior Guilt Procrastination

Additional Areas

Career Issues Sexual Problems Pain Control Relationships Interview Skills Fertility Hearing Childhood Problems Nerves IVF Sight/Vision Sleep Problems Public Speaking Conception Mobility Concentration Pregnancy Skin Problems Exams Birth Hair Growth Memory Driving Skills

Your information is confidential and will only be seen by Adrienne.

✓

You're All Set

Your consultation request has been received. I will review your responses and reach out within 24 to 48 hours to schedule your free 30-minute consultation at a time that works for you.

Looking forward to connecting with you.

← Back to AhHah Hypnosis

This form is for preparation purposes only and does not constitute a medical or psychological assessment. Hypnotherapy is an educational and personal development service.