Client Intake Form-2

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Pleae complete this form to provide additional detailed information for your consultation or session appointment.

Name *

First

Last Name

Untitled

Written permission is required from parent or guardian for minors.

Email *

What is it that you want? Be specific and use ONLY positive statements.

Think of what you are moving toward, not what you are moving away from.

What is important to you about this? *

What do you want from this? *

What would that do for you? *

How will you know when you have it? *

How will this affect other people in your life? *

What stops you from having this already? *

What resources do you already have that will help you achieve this? *

What else do you need? *

What are the first steps you need to take? *

Captcha

Tom Wood, CH, C.NLP

I am a board certified Consulting Hypnotist through the National Guild of Hypnotists, Inc. I started the Hypnosis Success Center in 2005. I have offices in Council Bluffs, IA, and Atlantic IA. The modalities I use in my business include 5-PATH hypnosis, neural-linguistic programming (NLP), Emotional Freedom Technique (EFT), Reiki and Energy Healing techniques. I teach Reiki and self-hypnosis classes. I offer workshops for meditation, weight reduction, EFT and Energy Healing. I am available for speaking engagements.

Hypnosis Success Center, LLC

Tom Wood, CH, C.NLP