{"id":1545,"date":"2022-02-28T14:44:23","date_gmt":"2022-02-28T14:44:23","guid":{"rendered":"https:\/\/olivebranchhypnotherapy.com\/?page_id=1545"},"modified":"2024-06-06T07:06:22","modified_gmt":"2024-06-06T07:06:22","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/","title":{"rendered":"BOOK AN Appointment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1545\" class=\"elementor elementor-1545\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d7623c8 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"d7623c8\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5e74755\" data-id=\"5e74755\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-39b1036 elementor-widget elementor-widget-heading\" data-id=\"39b1036\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">\u2018If you do not change direction, you may end up where you are heading\u2019\n\n<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3693292 elementor-widget elementor-widget-heading\" data-id=\"3693292\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">\n\nSiddh\u0101rtha Gautama<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bb7214f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bb7214f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-663aa84\" data-id=\"663aa84\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-29e8ede elementor-widget elementor-widget-heading\" data-id=\"29e8ede\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Scheduling Your Session<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5c35722 elementor-widget elementor-widget-text-editor\" data-id=\"5c35722\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Once you have completed the below Client Intake Form, I will call you for a quick FREE, no-obligation, 15 min consultation chat, to determine your desired goals, we will then discuss the best time to schedule your first session.<\/span><\/p><p>\u00a0<\/p><p><span style=\"font-weight: 400;\">Your first scheduled session should take around 90 mins.\u00a0If at any time in those first 30 mins you determine there isn&#8217;t a good fit, we can end the session there,\u00a0no obligation and no cost to you &#8211; a risk free way to make sure this is right for you.<\/span><\/p><p>\u00a0<\/p><p><span style=\"font-weight: 400;\">In the 90 mins <\/span><span style=\"font-weight: 400;\">we will discuss your issue and together devise a treatment plan to achieve what you need. In our first session, we will jointly establish a set of agreed therapeutic goals and commence treatment. Many clients notice marked changes and improvements after their first appointment.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">All future follow-up sessions are 60 minutes.<\/span><\/p><p><span style=\"font-weight: 400;\">\u00a0\u200b<\/span><\/p><p><span style=\"font-weight: 400;\">The number of follow up sessions will depend on your commitment and how you progress. Often clients see great results from the very first session, and treatment packages of 3 or more sessions are available at a discounted rate.\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Any further sessions are used to target\u00a0other identified problem areas and obstacles to progress.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e262292 elementor-widget elementor-widget-button\" data-id=\"e262292\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm elementor-animation-bob\" href=\"https:\/\/olivebranchhypnotherapy.com\/index.php\/services\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">VIEW SERVICES<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-69951ba\" data-id=\"69951ba\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-73275ff elementor-widget elementor-widget-image\" data-id=\"73275ff\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1920\" height=\"2560\" src=\"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-scaled.jpg\" class=\"attachment-full size-full wp-image-1475\" alt=\"\" srcset=\"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-scaled.jpg 1920w, https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-225x300.jpg 225w, https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-768x1024.jpg 768w, https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-1152x1536.jpg 1152w, https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-1536x2048.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f7a46d2 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"f7a46d2\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3006a3f\" data-id=\"3006a3f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a606c8c elementor-widget elementor-widget-heading\" data-id=\"a606c8c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">CLIENT INTAKE & CONSENT FORM<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-68537fe elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"68537fe\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5ed3a1f\" data-id=\"5ed3a1f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5c61451 elementor-widget elementor-widget-text-editor\" data-id=\"5c61451\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Please fill out this form prior to your first appointment.<br \/>The following information will be used to help plan your hypnotherapy sessions. Please answer<br \/>the questions to the best of your knowledge.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-57f7d96 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"57f7d96\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c8d9389\" data-id=\"c8d9389\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a8d4dff elementor-button-align-start elementor-widget elementor-widget-form\" data-id=\"a8d4dff\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1545\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"a8d4dff\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Olive Branch Hypnotherapy\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Full Name\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-message elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Address\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d980155 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d980155]\" id=\"form-field-field_d980155\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\/State\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_8d36e0a elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_8d36e0a]\" id=\"form-field-field_8d36e0a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Postal Code\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_d4b4bf0 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_d4b4bf0]\" id=\"form-field-field_d4b4bf0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_cbfbdf8 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cbfbdf8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Under 16\" id=\"form-field-field_cbfbdf8-0\" name=\"form_fields[field_cbfbdf8][]\"> <label for=\"form-field-field_cbfbdf8-0\">Under 16<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"16-30\" id=\"form-field-field_cbfbdf8-1\" name=\"form_fields[field_cbfbdf8][]\"> <label for=\"form-field-field_cbfbdf8-1\">16-30<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"30-50\" id=\"form-field-field_cbfbdf8-2\" name=\"form_fields[field_cbfbdf8][]\"> <label for=\"form-field-field_cbfbdf8-2\">30-50<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"50-60\" id=\"form-field-field_cbfbdf8-3\" name=\"form_fields[field_cbfbdf8][]\"> <label for=\"form-field-field_cbfbdf8-3\">50-60<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"60-70\" id=\"form-field-field_cbfbdf8-4\" name=\"form_fields[field_cbfbdf8][]\"> <label for=\"form-field-field_cbfbdf8-4\">60-70<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"70+\" id=\"form-field-field_cbfbdf8-5\" name=\"form_fields[field_cbfbdf8][]\"> <label for=\"form-field-field_cbfbdf8-5\">70+<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-25 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_8256013 elementor-col-75\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8256013\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t(Your email address will be used for appointment confirmations, and quarterly newsletters) If you would like to subscribe to our newsletter and promotions please tick YES or tick NO\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_8256013-0\" name=\"form_fields[field_8256013][]\"> <label for=\"form-field-field_8256013-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_8256013-1\" name=\"form_fields[field_8256013][]\"> <label for=\"form-field-field_8256013-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3a2b138 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3a2b138]\" id=\"form-field-field_3a2b138\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Marital Status\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_549dddd elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_549dddd]\" id=\"form-field-field_549dddd\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Occupation\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_66cddbf elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_66cddbf]\" id=\"form-field-field_66cddbf\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Emergency Contact Name\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_bd42ff2 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_bd42ff2]\" id=\"form-field-field_bd42ff2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Emergency Contact Phone\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_75d85de elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_75d85de\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you currently taking any medication?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_75d85de-0\" name=\"form_fields[field_75d85de][]\"> <label for=\"form-field-field_75d85de-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"NO\" id=\"form-field-field_75d85de-1\" name=\"form_fields[field_75d85de][]\"> <label for=\"form-field-field_75d85de-1\">NO<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e424825 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_e424825]\" id=\"form-field-field_e424825\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If yes, what is it and why was it prescribed?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_6bd76ff elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6bd76ff\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you currently under the care of another Therapist?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_6bd76ff-0\" name=\"form_fields[field_6bd76ff][]\"> <label for=\"form-field-field_6bd76ff-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_6bd76ff-1\" name=\"form_fields[field_6bd76ff][]\"> <label for=\"form-field-field_6bd76ff-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b1e9687 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b1e9687]\" id=\"form-field-field_b1e9687\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Are you currently under the care of another Therapist?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c946d5f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c946d5f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you had Hypnotherapy before?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_c946d5f-0\" name=\"form_fields[field_c946d5f][]\"> <label for=\"form-field-field_c946d5f-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_c946d5f-1\" name=\"form_fields[field_c946d5f][]\"> <label for=\"form-field-field_c946d5f-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_2cea31d elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2cea31d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, do you know what type of Hypnotherapy it was?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Traditional script reading\" id=\"form-field-field_2cea31d-0\" name=\"form_fields[field_2cea31d][]\"> <label for=\"form-field-field_2cea31d-0\">Traditional script reading<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ericksonian Permissive\" id=\"form-field-field_2cea31d-1\" name=\"form_fields[field_2cea31d][]\"> <label for=\"form-field-field_2cea31d-1\">Ericksonian Permissive<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"I don&#039;t know\" id=\"form-field-field_2cea31d-2\" name=\"form_fields[field_2cea31d][]\"> <label for=\"form-field-field_2cea31d-2\">I don't know<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_55e5376 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_55e5376\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you a smoker?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_55e5376-0\" name=\"form_fields[field_55e5376][]\"> <label for=\"form-field-field_55e5376-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_55e5376-1\" name=\"form_fields[field_55e5376][]\"> <label for=\"form-field-field_55e5376-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_2a91f6a elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2a91f6a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you consume alcohol?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_2a91f6a-0\" name=\"form_fields[field_2a91f6a][]\"> <label for=\"form-field-field_2a91f6a-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_2a91f6a-1\" name=\"form_fields[field_2a91f6a][]\"> <label for=\"form-field-field_2a91f6a-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_4b50706 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4b50706\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, describe your alcohol consumption?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Occassionally\" id=\"form-field-field_4b50706-0\" name=\"form_fields[field_4b50706][]\"> <label for=\"form-field-field_4b50706-0\">Occassionally<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Every day\" id=\"form-field-field_4b50706-1\" name=\"form_fields[field_4b50706][]\"> <label for=\"form-field-field_4b50706-1\">Every day<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"A glass or two at night\" id=\"form-field-field_4b50706-2\" name=\"form_fields[field_4b50706][]\"> <label for=\"form-field-field_4b50706-2\">A glass or two at night<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Socially\" id=\"form-field-field_4b50706-3\" name=\"form_fields[field_4b50706][]\"> <label for=\"form-field-field_4b50706-3\">Socially<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Occasional binges\" id=\"form-field-field_4b50706-4\" name=\"form_fields[field_4b50706][]\"> <label for=\"form-field-field_4b50706-4\">Occasional binges<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"I use it to help me sleep\" id=\"form-field-field_4b50706-5\" name=\"form_fields[field_4b50706][]\"> <label for=\"form-field-field_4b50706-5\">I use it to help me sleep<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9ae81a0 elementor-col-80\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9ae81a0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you suffered from any of the following?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Depression\" id=\"form-field-field_9ae81a0-0\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-0\">Depression<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Anxiety\" id=\"form-field-field_9ae81a0-1\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-1\">Anxiety<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"ADHD\/ADD\" id=\"form-field-field_9ae81a0-2\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-2\">ADHD\/ADD<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Chronic Insomnia\" id=\"form-field-field_9ae81a0-3\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-3\">Chronic Insomnia<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Phobias\" id=\"form-field-field_9ae81a0-4\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-4\">Phobias<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Addictions\" id=\"form-field-field_9ae81a0-5\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-5\">Addictions<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Compulsive Disorders\" id=\"form-field-field_9ae81a0-6\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-6\">Compulsive Disorders<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Drug Abuse\" id=\"form-field-field_9ae81a0-7\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-7\">Drug Abuse<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Eating Disorders\" id=\"form-field-field_9ae81a0-8\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-8\">Eating Disorders<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Schizophrenia\" id=\"form-field-field_9ae81a0-9\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-9\">Schizophrenia<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Bipolar Disorders\" id=\"form-field-field_9ae81a0-10\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-10\">Bipolar Disorders<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_9ae81a0-11\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-11\">Other<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"None of the above\" id=\"form-field-field_9ae81a0-12\" name=\"form_fields[field_9ae81a0][]\"> <label for=\"form-field-field_9ae81a0-12\">None of the above<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_23c892f elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_23c892f]\" id=\"form-field-field_23c892f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If the above answer is &quot;Other&quot; - and you wish to give details, please advise here\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_f9b8a6c elementor-col-60\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f9b8a6c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you suffer from any of the following?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Respiratory Problems\" id=\"form-field-field_f9b8a6c-0\" name=\"form_fields[field_f9b8a6c][]\"> <label for=\"form-field-field_f9b8a6c-0\">Respiratory Problems<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Digestive Issues\" id=\"form-field-field_f9b8a6c-1\" name=\"form_fields[field_f9b8a6c][]\"> <label for=\"form-field-field_f9b8a6c-1\">Digestive Issues<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"High\/Low Blood Pressure\" id=\"form-field-field_f9b8a6c-2\" name=\"form_fields[field_f9b8a6c][]\"> <label for=\"form-field-field_f9b8a6c-2\">High\/Low Blood Pressure<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Dizziness\/Fainting\" id=\"form-field-field_f9b8a6c-3\" name=\"form_fields[field_f9b8a6c][]\"> <label for=\"form-field-field_f9b8a6c-3\">Dizziness\/Fainting<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Back or Neck Pain\" id=\"form-field-field_f9b8a6c-4\" name=\"form_fields[field_f9b8a6c][]\"> <label for=\"form-field-field_f9b8a6c-4\">Back or Neck Pain<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Psoriasis\/Skin Complaints\" id=\"form-field-field_f9b8a6c-5\" name=\"form_fields[field_f9b8a6c][]\"> <label for=\"form-field-field_f9b8a6c-5\">Psoriasis\/Skin Complaints<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"None of the above\" id=\"form-field-field_f9b8a6c-6\" name=\"form_fields[field_f9b8a6c][]\"> <label for=\"form-field-field_f9b8a6c-6\">None of the above<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_3bf25eb elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3bf25eb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescribe your quality of sleep?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Good\" id=\"form-field-field_3bf25eb-0\" name=\"form_fields[field_3bf25eb][]\"> <label for=\"form-field-field_3bf25eb-0\">Good<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Average\" id=\"form-field-field_3bf25eb-1\" name=\"form_fields[field_3bf25eb][]\"> <label for=\"form-field-field_3bf25eb-1\">Average<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Poor\" id=\"form-field-field_3bf25eb-2\" name=\"form_fields[field_3bf25eb][]\"> <label for=\"form-field-field_3bf25eb-2\">Poor<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Variable\" id=\"form-field-field_3bf25eb-3\" name=\"form_fields[field_3bf25eb][]\"> <label for=\"form-field-field_3bf25eb-3\">Variable<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_2062af1 elementor-col-80\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2062af1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is it that you expect we can help you with?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Performance Anxiety \" id=\"form-field-field_2062af1-0\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-0\">Performance Anxiety <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Generalised Anxiety\" id=\"form-field-field_2062af1-1\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-1\">Generalised Anxiety<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Social Anxiety\" id=\"form-field-field_2062af1-2\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-2\">Social Anxiety<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Work Stress\" id=\"form-field-field_2062af1-3\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-3\">Work Stress<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Relationship Stress\" id=\"form-field-field_2062af1-4\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-4\">Relationship Stress<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Behavioural Modification\" id=\"form-field-field_2062af1-5\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-5\">Behavioural Modification<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Depression\" id=\"form-field-field_2062af1-6\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-6\">Depression<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Addictions\" id=\"form-field-field_2062af1-7\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-7\">Addictions<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Stop Drinking\" id=\"form-field-field_2062af1-8\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-8\">Stop Drinking<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Trauma\/PTSD\" id=\"form-field-field_2062af1-9\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-9\">Trauma\/PTSD<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Phobia \" id=\"form-field-field_2062af1-10\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-10\">Phobia <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Study Skills\/Memory\" id=\"form-field-field_2062af1-11\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-11\">Study Skills\/Memory<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Pain\/Post Operative Healing\" id=\"form-field-field_2062af1-12\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-12\">Pain\/Post Operative Healing<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_2062af1-13\" name=\"form_fields[field_2062af1][]\"> <label for=\"form-field-field_2062af1-13\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a0a72c8 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a0a72c8]\" id=\"form-field-field_a0a72c8\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If the above answer is &quot;Other&quot; - and you wish to give details, please advise here\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_8ab669f elementor-col-60\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8ab669f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow did you find out about Olive Branch Hypnotherapy ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Doctor&#039;s referral\" id=\"form-field-field_8ab669f-0\" name=\"form_fields[field_8ab669f][]\"> <label for=\"form-field-field_8ab669f-0\">Doctor's referral<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other Therapist\" id=\"form-field-field_8ab669f-1\" name=\"form_fields[field_8ab669f][]\"> <label for=\"form-field-field_8ab669f-1\">Other Therapist<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Friend\" id=\"form-field-field_8ab669f-2\" name=\"form_fields[field_8ab669f][]\"> <label for=\"form-field-field_8ab669f-2\">Friend<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Internet Search\" id=\"form-field-field_8ab669f-3\" name=\"form_fields[field_8ab669f][]\"> <label for=\"form-field-field_8ab669f-3\">Internet Search<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Advertising\" id=\"form-field-field_8ab669f-4\" name=\"form_fields[field_8ab669f][]\"> <label for=\"form-field-field_8ab669f-4\">Advertising<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_8ab669f-5\" name=\"form_fields[field_8ab669f][]\"> <label for=\"form-field-field_8ab669f-5\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_7aa8fbb elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7aa8fbb]\" id=\"form-field-field_7aa8fbb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name of Referring Doctor\/Friend\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b706ac6 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b706ac6]\" id=\"form-field-field_b706ac6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If the above answer is &quot;Other&quot; - and you wish to give details, please advise here\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_ba21277 elementor-col-30\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ba21277\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you member of a health fund?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_ba21277-0\" name=\"form_fields[field_ba21277][]\"> <label for=\"form-field-field_ba21277-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_ba21277-1\" name=\"form_fields[field_ba21277][]\"> <label for=\"form-field-field_ba21277-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_d8a60a8 elementor-col-70\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d8a60a8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tN.B. Health fund rebates vary between funds and levels of cover. Additionally, changes in policy can occur any time. We cannot tell you if your particular insurance policy will cover your hypnotherapy sessions, or what your rebate will be.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"I Agree\" id=\"form-field-field_d8a60a8-0\" name=\"form_fields[field_d8a60a8][]\"> <label for=\"form-field-field_d8a60a8-0\">I Agree<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"I Disagree\" id=\"form-field-field_d8a60a8-1\" name=\"form_fields[field_d8a60a8][]\"> <label for=\"form-field-field_d8a60a8-1\">I Disagree<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_8458b39 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8458b39\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCancellation Policy\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_8458b39]\" id=\"form-field-field_8458b39\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-field_8458b39\">I acknowledge that unless I give 24 hours notice of a session cancellation I may be charged in full.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_59b30c3 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_59b30c3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tConfidentiality\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_59b30c3]\" id=\"form-field-field_59b30c3\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-field_59b30c3\">I am fully informed of the laws of confidentiality and the mandatory obligations of my therapist. \n\n\n(Your session is subject to the rules of confidentiality. Nothing you disclose will leave the room or be relayed to others. However, there are exceptions to the rules of confidentiality. Any situation where you are at risk of harming yourself or others, or your involvement in a serious crime, I as a Mandatory Reporter, would be legally bound to report these incidents to the authorities. If you are concerned, please research Confidentiality and Mandatory Reporting and arrive fully informed.)<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_50fac11 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_50fac11\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tInformed Consent\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_50fac11]\" id=\"form-field-field_50fac11\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-field_50fac11\">I agree to the use of hypnosis as a treatment tool during my clinical hypnosis session.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_175aab0 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_175aab0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCancellation Policy\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_175aab0]\" id=\"form-field-field_175aab0\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-field_175aab0\">I acknowledge that I, unless I give 24 hours notice of a session cancellation, I may be charged in full.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_1b17556 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1b17556\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDisclosure\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_1b17556]\" id=\"form-field-field_1b17556\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-field_1b17556\">I understand that if I disclose that I have or intend to commit certain criminal offenses, the Therapist is obliged by law to report me to the authorities.\n<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-sm elementor-animation-bob\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u2018If you do not change direction, you may end up where you are heading\u2019 Siddh\u0101rtha Gautama Scheduling Your Session Once you have completed the below Client Intake Form, I will call you for a quick FREE, no-obligation, 15 min consultation chat, to determine your desired goals, we will then discuss the best time to schedule &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/\"> <span class=\"screen-reader-text\">BOOK AN Appointment<\/span> Read More &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>BOOK AN Appointment - Olive Branch Hypnotherapy<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"BOOK AN Appointment - Olive Branch Hypnotherapy\" \/>\n<meta property=\"og:description\" content=\"\u2018If you do not change direction, you may end up where you are heading\u2019 Siddh\u0101rtha Gautama Scheduling Your Session Once you have completed the below Client Intake Form, I will call you for a quick FREE, no-obligation, 15 min consultation chat, to determine your desired goals, we will then discuss the best time to schedule &hellip; BOOK AN Appointment Read More &raquo;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/\" \/>\n<meta property=\"og:site_name\" content=\"Olive Branch Hypnotherapy\" \/>\n<meta property=\"article:modified_time\" content=\"2024-06-06T07:06:22+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-scaled.jpg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/\",\"url\":\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/\",\"name\":\"BOOK AN Appointment - Olive Branch Hypnotherapy\",\"isPartOf\":{\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/#website\"},\"datePublished\":\"2022-02-28T14:44:23+00:00\",\"dateModified\":\"2024-06-06T07:06:22+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/olivebranchhypnotherapy.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"BOOK AN Appointment\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/#website\",\"url\":\"https:\/\/olivebranchhypnotherapy.com\/\",\"name\":\"Olive Branch Hypnotherapy\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/olivebranchhypnotherapy.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/#organization\",\"name\":\"Olive Branch Hypnotherapy\",\"url\":\"https:\/\/olivebranchhypnotherapy.com\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/cropped-olive_branch_hypnotherapy__1_-removebg-preview-1.png\",\"contentUrl\":\"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/cropped-olive_branch_hypnotherapy__1_-removebg-preview-1.png\",\"width\":323,\"height\":309,\"caption\":\"Olive Branch Hypnotherapy\"},\"image\":{\"@id\":\"https:\/\/olivebranchhypnotherapy.com\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"BOOK AN Appointment - Olive Branch Hypnotherapy","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/","og_locale":"en_US","og_type":"article","og_title":"BOOK AN Appointment - Olive Branch Hypnotherapy","og_description":"\u2018If you do not change direction, you may end up where you are heading\u2019 Siddh\u0101rtha Gautama Scheduling Your Session Once you have completed the below Client Intake Form, I will call you for a quick FREE, no-obligation, 15 min consultation chat, to determine your desired goals, we will then discuss the best time to schedule &hellip; BOOK AN Appointment Read More &raquo;","og_url":"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/","og_site_name":"Olive Branch Hypnotherapy","article_modified_time":"2024-06-06T07:06:22+00:00","og_image":[{"url":"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/youssef-naddam-iJ2IG8ckCpA-unsplash-scaled.jpg"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/","url":"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/","name":"BOOK AN Appointment - Olive Branch Hypnotherapy","isPartOf":{"@id":"https:\/\/olivebranchhypnotherapy.com\/#website"},"datePublished":"2022-02-28T14:44:23+00:00","dateModified":"2024-06-06T07:06:22+00:00","breadcrumb":{"@id":"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/olivebranchhypnotherapy.com\/index.php\/book-an-appointment\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/olivebranchhypnotherapy.com\/"},{"@type":"ListItem","position":2,"name":"BOOK AN Appointment"}]},{"@type":"WebSite","@id":"https:\/\/olivebranchhypnotherapy.com\/#website","url":"https:\/\/olivebranchhypnotherapy.com\/","name":"Olive Branch Hypnotherapy","description":"","publisher":{"@id":"https:\/\/olivebranchhypnotherapy.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/olivebranchhypnotherapy.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/olivebranchhypnotherapy.com\/#organization","name":"Olive Branch Hypnotherapy","url":"https:\/\/olivebranchhypnotherapy.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/olivebranchhypnotherapy.com\/#\/schema\/logo\/image\/","url":"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/cropped-olive_branch_hypnotherapy__1_-removebg-preview-1.png","contentUrl":"https:\/\/olivebranchhypnotherapy.com\/wp-content\/uploads\/2022\/02\/cropped-olive_branch_hypnotherapy__1_-removebg-preview-1.png","width":323,"height":309,"caption":"Olive Branch Hypnotherapy"},"image":{"@id":"https:\/\/olivebranchhypnotherapy.com\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/pages\/1545"}],"collection":[{"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/comments?post=1545"}],"version-history":[{"count":100,"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/pages\/1545\/revisions"}],"predecessor-version":[{"id":1914,"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/pages\/1545\/revisions\/1914"}],"wp:attachment":[{"href":"https:\/\/olivebranchhypnotherapy.com\/index.php\/wp-json\/wp\/v2\/media?parent=1545"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}