NeuroTrust Application — Love Energy Wellness LLC

NeuroTRUST Hypnosis Method

Intake Form

NeuroTrust METhod intake form

Please fill out the following questions before booking your Complimentary Consultation so I have a better understanding of your goals.

After you apply, you will be automatically redirected to our Complimentary Consultation Booking page. Please schedule your free session at your convenience.

Name

First Name

Last Name

On a scale from 1-10 (10 being the greatest), how committed are you to making permanent change for improvement?

What struggles are you facing in your life or business?

How do these struggles make you feel?

How do you want to feel in your life or business?

What do you want your life to look like 90 days from now?

What’s getting in the way of that?

Is there anything else you'd like me to know?