John Moonie, HPD, SQHP, GHR(Reg.), NHR

(01738) 561889 or 07784 25 77 76 (mob.)

Hypnosis Perth Scotland clients from Dundee, Angus, Perthshire (Tayside), Fife & Kinross. Falkirk, Stirling, Aberdeen, Edinburgh, Glasgow.

HYPNOTHERAPY TRAINING SCOTLAND

Diploma in Analytical Hypnotherapy

Course Application Form

Address Line 1

Medical

Have you ever suffered from epilepsy?

Consulted a psychiatrist or psychotherapist?

Do you currently have any medical problems or disabilities?

Education

Occupation

Hypnosis/Hypnotherapy Experience. Your ambitions.

Now press “submit” button to apply.

Title - Mr/Mrs/Miss/Other

Full Name

Date of Birth dd/mm/yyyy

Address/Contact Details

Address Line 2

City/Town

County/District

Country

Postal/Zip Code

Telephone no.

Mobile Number

Email Address

Re-key Email Address

Special diet? (Details or “none”)

Education History

Secondary/tertiary

Where

When

Qualifications achieved

Current

From (dates in dd/mm/yyyy format)

Previous Occupation(s)

Brief details or “none”

Hypnosis/Hypnotherapy Experience

Brief details (dates?, what?) if any experience as a client or therapist. Any previous training.

Motivation/ambitions

E.g. What you hope to achieve from this course and how you feel this will help your clients (paying or not).

Which course are you interested in?

Personal Details

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Terms and Conditions

1. Only on acceptance, and provided you wish to go ahead and book or pay in full for the course, payment is by cash (by arrangement), cheque or money order - cheques, etc. Payable to “John Moonie” and as advised. PayPal may be available.

Send to:- John Moonie, HypnoPerth, 11, Fraser Terrace, PERTH, SCOTLAND, UK PH1 1BX .

2. The course will proceed with a minimum of 2 fully-paid students and a suitable finally booked venue is secured if it is not my practice address.

3. A full refund of the enrolment fee or full course fee (if paid) will be given in the event that the course does not proceed for any reason, or you are not accepted for the course, or if I am unable to present the course at all due to unforeseen circumstances.

A partial refund will be made if I am unable to present some part(s) of the course - in this event a pro-rata refund will be made by cheque to your name at the address above on clearance of your own cheque or other payment.All reasonable efforts will then be made to deliver the remainder of the course as soon as practicable.

4. Once the course is confirmed as proceeding and cheques have been cashed there will be no other circumstances other than mentioned in point 3. where refunds will be considered. E.g. Students departing prior to completion on their own decision.

5. You should consider taking out your own insurance against your inability to attend or complete the course e.g. through illness or other unforeseen but insurable circumstances.

I agree to abide fully by the terms and conditions of this course application by pressing the ‘Submit’ button above.

What Is Hypnosis

What Hypnosis Can Do

Typical Hypnotherapy Session

Gastric Band CD

Blushing CD

Driving Confidently CD

Relaxation & Confidence CD

Weight Control CD

Flying Comfortably CD

Insomnia CD

Smoking CD