INTAKE - Anke Docherty Coaching

Thank you for signing up for your RTT session!

Please watch this video to learn more about your RTT session.

Please fill out the below Intake Form, which will ensure that you get the most out of your session.

What is your name?

What is your email address?

What is your postal address?

What is your mobile number (include your country code)?

What is your date of birth?

Are you currently on medication? If yes, what medication?

Have you had or do you currently have any major health problems? If yes, list them below.

What are your current areas of concern that you wish to work on?

If you could find a cure for one issue in your upcoming session, which issue would that be?

Describe in a few sentences what your life would look like, if you no longer suffered from this issue.

On a scale from 1 to 10 (one being the lowest, 10 being the highest), how committed are you to solving this issue?

Have you ever been hypnotized before?