Application for a Personal Breakthrough Session
Please complete this short form to apply for a session. I only open up a few places a month for this to ensure that I can fully support and hold you in this transformational space.
All of the information you provide is treated in the strictest of confidence and is not shared with anyone else.
Once you have completed and submitted this, I will personally be in touch within 48 hours.
Name *
Email *
Address *
Phone number
If you could have anything as a result of this session, what would you want? *
What do you currently have in your life that you no longer want?
Write a short life history including any events that were significant to you (both positive and negative):
What patterns have you noticed in your life so far?
What have you done about it so far?
Are you currently undergoing any other therapy/mental health support? If so, please give details below: *
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