Private Session Application | Attieh Hypnotherapy

Request an Introductory Conversation

Thank you for your interest in working with me. Please complete the short application below to share a little about what you would like to change.

After submitting your application, you'll be taken directly to my calendar to schedule a complimentary 15-minute introductory conversation. I'll review your application before we speak.

If you don't receive your confirmation emails in your inbox, please check your spam or junk folder.

Please note: Keep your answers brief and share only what you feel comfortable sharing. Do not include medical records, diagnoses, medication information, or other sensitive health or personal information.

Privacy: Your information will be used to review your request and prepare for our conversation. Please see my Privacy Policy for details about how your information is collected, used, and handled.

First name

Last name

Where are you located? Please provide your city, state/province, and country.

What would you like to change?

When this changes in the way you hope, what will be different for you?

How long has this been something you would like to change?

Less than 6 months

6-12 months

1-3 years

More than 3 years

What have you already tried to make this change, if anything?

Have you experienced hypnosis or hypnotherapy before?

Yes, with a hypnotherapy practitioner.

Yes, through self-hypnosis or guided hypnosis recordings.

No, this would be my first experience.

I confirm that I am 18 years of age or older. I understand that an introductory conversation does not guarantee that we will work together, and that hypnotherapy services are intended for personal development and self-improvement, not as a substitute for medical or mental healthcare.