Mind Hack Wellbeing Registration Form

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Please fill in a few details about yourself, know that under GDPR regulations, your contact details are kept secure, will not be shared with anyone and you will only receive contact from Mind Hack Wellbeing in relation to our services in particular.

Name *

Email *

Address *

Phone number

Are you interested in attending a Workshop or 1:1 Treatment? *

Workshop (max 6 people per course)

Private 1:1

What would you like to change?

What would life be like for you once the change has been made?

Is there anything else that you'd like to mention?

Check Your Information

Please check that your contact information is correct before submitting the form. Sarah-Jane will attempt to contact you shortly by phone to book your consultation, if you miss her call she will follow up with an email.

Submit

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