First Name

Last Name

Email Address

Have you tried hypnosis before? Have you tried hypnosis before?YesNo

Could you share what you aim to achieve through our Introductory Holistic Healing Hypnosis? Your specific goals and expectations would help us tailor the session to your needs. Write in the box.

What life event(s) have led you to explore self-hypnosis, and why is now the right time for you? Write in the box.

What would be the long-term impact on your life, including your finances, career, and family, if you continue with your current lifestyle or habits? Write in the box.

What does your ideal lifestyle look like, or if you were starting with a blank slate, how would you envision living your life? How would you choose to spend your time? Write in the box.

What do you believe is holding you back living your ideal life? Write in the box.

On a scale from 1 to 5, how urgently do you feel the need for assistance or a positive change in your life right now? 1 means not urgent and 5 means very urgent. Write in the box.

How much have you invested in yourself over the last 12 months? Eg. Courses, training & online mentorship? Write in the box.

If you were to assign a monetary value, what would be the cost of your dream life? Consider providing an estimate in terms of both time and money—perhaps £100,000 or £10,000. If you were to adopt that lifestyle immediately, how much money would you need to sustain it? Write in the box.

Given the value you place on achieving your dream life and your dedication to personal growth, how much are you prepared to invest in your personal development to realize that dream? Given the value you place on achieving your dream life and your dedication to personal growth, how much are you prepared to invest in your personal development to realize that dream? £8,001 above/month £6,0001-£8,001/month £5,001-£6,000/month £4,001-£5,000/month £3,000-£4,000/month

Age and Diagnoses: Age and Diagnoses: I can confirm that I am over 17 years old and I am NOT diagnose with Alzheimer or Schizophrenia.

Terms and Conditions and Privacy Policy: Terms and Conditions and Privacy Policy: I agree and understand the Terms and Conditions and Privacy Policy. I agree to fully release and hold harmless, Flora Mae Stafford (Growth Teacher) from and against any all and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

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