Online Consent Form

I, (Full name)

Of, (Your address)

Email Address:

Mobile No:

Hereby consent to receiving Solution Focused Hypnotherapy From:
(Therapist’s Name)

Dr’s Practice

Do I have permission to contact your GP?
YesNo

Do you consent to receiving hypnotherapy?
YesNo

Have you received a copy of my GDPR notice?
YesNo

Date

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