Phobia Application for Consultation – Shawn Robertson Hypnosis

Application for a Phobia/Fear Consultation

I will use your answers to evaluate whether it makes sense for us to work together. Afterwards, all answers will then be deleted and no records kept. This does not put you on any email list.

First Name

1. Please describe the challenge you are facing.

2. How much is this issue interfering with your life as you want to live it?

3. What is your desired outcome?

4. Why now? Is there a particular reason you want to do this now?

5. What have you done to address this issue up until now?

6. Are you taking medication that numbs emotion or makes it hard to concentrate?

7. Do you have a medical diagnosis of schizophrenia or psychosis?

8. I understand that a targeted coaching program consists of 4 sessions with a total cost of 650 CHF ($690 US)

9. Is there anything else that you think it would be helpful for me to know?