Request for Consultation

First name

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Email

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Preferred Method of Contact

Phone Call

Email

Have you been hypnotized before?

Yes

No

What is the change you want to make in yourself?

Sessions take place virtually. If you have a special need or circumstance that requires an in-person session, please indicate so below.

Yes, I require an in-person appointment.

In-Person Sessions Take Place in Chatham, Ontario

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