www.sydneyhypno.com.au - Client Intake Form


Hello and Welcome!

Thank you for coming here to start the process of engagement in your therapeutic process of healing through strategic therapies and coaching. 

(Please note that this form is also used for those who come to me for Training, Coaching and Mentoring services and also those Therapists who are registering with Kerry for their Mandatory Therapist Supervision Services (Noting that  Group & One on One Supervisions available from Nov 2023).

We start with you completing this Client Intake Form. 

Once this form is completed, you can expect a free (Zero Cost) 15 minute consultation via phone - so that we can determine the best next step for you, and at this time, if it suits you to go forward,  we can work out the best mutually acceptable appointment time. (if we haven't already done this prior to you completing this form of course)  

This form is an important first step for us both,  as it allows me to really assist you to help you get the results you want.  As you are a unique individual, answering these answers will help me to design a tailored program to identify the goals and outcomes specific to you, that we will work on together to achieve.

To ensure I get all of the important details about you,  so we are working within scope,  there will be some questions where I will require a response on the form.   Those questions you will see as you go along, will say that an  "Answer is required" - Please note that the form can't be submitted until those questions are answered . (as they are also an important part of my requirement as your therapist to be as a fully informed as possible to provide proper Duty of Care)

If you have any issues with the form - please call on M:  0412-412-881 - or email:  kerry@sydneyhypno.com.au

Then I will be able to call you back to assist you with this process if you need this help.  (please let me know on your message what would be a good time to call back as I will generally be calling you back in between client sessions)

I look forward to our working together to reach your goals!

Thank you again, 



M: 0412-412-881


Client Information

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Full Address please, Street #, Street Name , Suburb, State & Country

Full Address please, Street #, Street Name , Suburb, State & Country

www.SydneyHypno.com.au   (ABN 34 137 510 751)               Kerry Bailey                      m:  0412-412-881

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