Therapy Enquiry Form - Weight Management
All enquiries are entirely confidential. The details you provide are for the purposes of this enquiry only and will never be passed to a third party.
I am interested in: *
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Full Name *
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Known as *
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Date of Birth *
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Age *
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Address *
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Telephone Number *
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Email Address *
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Are you taking any medication? *
Details
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Relevant Medical History
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How did you hear about me? *
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How can I help you? *
Please give as much or as little information as you wish, about why you are seeking therapy.
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What is your current weight? *
Your answer
What is your height? *
Your answer
What would you like to weigh? *
Your answer
Please give me some details about previous diets, current diet and lifestyle. *
Your answer
Please list your 'danger' foods:
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Do you exercise? *
Details:
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Is there anything else you think I should know?
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Where would you prefer to be seen? *
Please tick as many or as few as are appropriate:
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When would you prefer to be seen? *
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How would you like me to contact you? *
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Terms and Conditions
I am a fully qualified, registered and insured Clinical Hypnotherapist, Counsellor and Mind Coach. All my work is carried out in line with the code of ethics and conduct of the National Council for Hypnotherapy (NCH); a copy is available on their website.

Hypnotherapy and Counselling can be extremely effective; however there can be no ‘guarantee’ of a cure for any given condition. Therapy requires commitment and motivation from both the therapist and the client to achieve the best results and whilst I will always do my absolute best for you, I do not have a magic wand. My sessions contain a mixture of therapies and techniques, depending upon your individual needs. I will always discuss these with you.

Fees are charged by the session, with discounts available for block bookings, when paid in advance.

Sessions normally last 50 – 60 minutes, although 90 minute sessions are available where appropriate.

Cancelling an Appointment:

Please give as much notice as possible if you wish to change or cancel an appointment.

Less than 24 hours' notice will incur a charge of 50% of the fee with 100% being charged for non-arrival.

Arriving Late for an Appointment:

If you are running late, please let me know as soon as possible. I will do my best to accommodate this, but if I have an appointment immediately after yours, your session may need to be curtailed. The full fee will still be payable if your session has to be curtailed due to your late arrival.

Mutual Respect:

I undertake to treat you with respect and am always respectful of the trust you put in me. I will use best practice at all times in our mutual interest. In return, you undertake not to harm yourself, or me, or any property belonging either to me or any other person during our sessions. You agree not to come to sessions under the influence of alcohol or recreational drugs, except those medications prescribed by your doctor. If you do come to sessions under the influence of alcohol or recreational drugs, or if you demonstrate violent or abusive behaviour, I reserve the right to cancel the session and refuse any further therapy sessions.

Psychosexual / Fetish Therapy:

It is important that you fully understand that this is not a physical therapy; it is a talking therapy.

I have read and accept the Terms and Conditions *
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GDPR Compliance
The details you provide are for the purpose of this enquiry only and will never be used for anything other than your treatment. Information you provide will be held securely by me, and will never be passed to a third party.

By ticking the boxes, you are agreeing to being contacted, by me in response to this enquiry, and to your details being held securely for the purpose of any treatment you undertake.

I consent to being contacted by Franca Hood in relation to this enquiry. *
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I consent to Franca Hood holding my details, securely, for the purpose of my treatment. *
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