LCAM Discovery call application form

DISCOVERY CALL

Application For NLP or Hypnotherapy Session

with Laurie Conrod,

MNLP, CCHt, MTT, EFTP, MSC

Please consider my application for a one-on-one session and, if accepted, contact me to book my appointment for a consultation call (Zoom) to find out if I'm a good fit for one of these sessions.

Full Name:

Email:

Phone:

Client Age:

Location and Time Zone:

Please provide a description of the current struggle the client is experiencing:

Please describe any previous experiences with NLP, hypnosis, coaching, EFT:

Please describe any behavior or emotional issues that you feel might be relevant:

In your own words, please describe any significant emotional events during the most recent three years:

Is the client currently under the care of a physician, psychotherapist, or any other licensed practitioner for this issue?

If yes, please explain the condition(s) for which the client is being treated and the nature of the treatment(s) including any medications:

Please include any additional information which you believe may be relevant to the current struggle(s).

Please describe as clearly as possible the results that you (the client) would like to achieve:

How did you hear about us?

Yes! I am committed to taking my life to the next level!

Check this box if you give us permission to contact you via SMS. Message and data rates may apply. Reply STOP to opt out of further messaging.

We respect your email privacy

Your submission is completely confidential.

We do not sell or send your information to 3rd parties.

After your application is reviewed we will contact you to schedule a consultation call.

Please make sure all your contact information is correct.

By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging and get more help by sending HELP.