Can you: 1. Please ensure you fill in the intake form below in FULL for your first session. Subsequent sessions will only require your name and email. 2. Once submitted, bookings will only be accepted once a corresponding payment has been made. 3. Please allow at least 24 hours after payment has been made to receive confirmation of the booking. If you have made a booking but you have not received a confirmation, be sure to check your spam/junk folder. Payment Options Wise (Preferred): g.filotto@icloud.com[Join Wise]Paypal: filotto@gmail.com Booking Calendar Calendar is loading... - Available - Booked - Pending Time Slots (Italian time GMT+1)*: 9:00 AM - 10:00 AM 10:20 AM - 11:20 AM 11:40 AM - 12:40PM 1:00 PM - 2:00 PM 2:20 PM - 3:20 PM 3:40 PM - 4:40 PM 5:00 PM - 6:00 PM 6:20 PM - 7:20 PM 7:40 PM - 8:40 PM 9:00 PM - 10:00 PM First Name*: Last Name*: Email*: Phone (Please include prefix (e.g. +44 if in the UK)): Sex: Male Female Marital Status: Married Divorced Widowed Engaged In a relationship Single Other If relevant, please give additional information about your relationship status: Have you ever been treated for (please select): Diabetes Epilepsy Heart Disorder Digestive Problems None of the Above Have you ever been treated for an emotional problem or clinically diagnosed condition (e.g. Clinical depression, schizophrenia, bulimia or anorexia nervosa): Yes No If Yes please give a brief description: Have you ever been hypnotised before?: Yes No If Yes please give a brief description: What do you want to accomplish through the use of hypnosis (only make a brief statement here as a full interview process will be done with you by the hypnotherapist): Any previous efforts to solve this problem?: Yes No Method? (brief description only): Results? (brief description only): Do You have any fears or phobias?: Yes No If yes, please describe: Send