Hypnotherapy Programme Application Form

Online Solution-Focused Hypnotherapy Pilot Programme

For People Living with Neuroendocrine Cancer

Thank you for your interest in this 8-week online Solution-Focused Hypnotherapy pilot programme.

This pilot programme has been designed to support people living with neuroendocrine cancer related anxiety, pain, fatigue and dietary challenges.

Please read through this form carefully BEFORE completing it

- if you have any questions please contact us by email at: support@nc-uk.org

If /when you are happy to proceed to complete this form, please do so as fully as you can — it helps us make sure the group is a good fit for you and that we can support you safely.

Please note:

This programme is offered alongside — and does not replace — any counselling, mindfulness, mental health programme or other support services you currently use.

Ability to commit

The programme runs for eight consecutive weeks, with one live online group session each week, lasting approximately 75 minutes. Before the programme begins, participants will attend a short online technical orientation session to ensure they are comfortable accessing the platform and understand how the programme will work.

Between sessions, participants will be encouraged to reinforce their learning and relaxation practice using:

Guided hypnosis audio recordings

Weekly reflective prompts and exercises

Practical techniques discussed during the live sessions

Regular engagement with these resources can help participants build the skills and confidence to apply what they learn in their everyday lives, supporting wellbeing throughout the programme and beyond. Please tick all to proceed - if you are unable to tick all - please contact us to discuss

I am able to commit to attending each of the 8 weekly online sessions of 75 minutes each, plus a short orientation session.I understand that I will be asked to complete a brief evaluation questionnaire at the start, midpoint and end of the programmeI also understand that I will be asked to complete a follow-up evaluation questionnaire at a specified time after the programme has finished.I am willing to try to use the shared recordings and practice self-care techniques in between sessions

Consent

To be able to process your application we need to ensure your understanding and consent to participate. Please tick all to proceed: if you are unable to tick all please contact us to discuss

I confirm that the information I have given on this form is accurate to the best of my knowledgeI consent to take part in this pilot study and understand that it is a feasibility study , not a guaranteed treatment outcomeI understand that my data will be stored securely and confidentially, in line with GDPR standards: it will only be used for the purposes of this pilot programme and its evaluationI understand that any information shared within group sessions is confidential to the group, and is NOT to be shared outside of the group - respecting fellow participants' confidentiality.I understand that I may withdraw from the programme at any time, without needing to give a reason and without this decision affecting any other care or support I receiveI consent to being contacted about the outcome of my application and, if accepted, to being contacted about scheduling and on-boarding.

THANK YOU

Thank you for completing this form.

The programme lead will review your application and will contact you to confirm and/or talk over any questions or concerns you may have.

If you do have any questions about the programme please do not hesitate in contacting us -
support@nc-uk.org