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Parent Coach, Hypnotherapist, NLP & IEMT Practitioner

Client Intake Form

Please complete the following information before your first session.

Boxes with an asterisk must be completed by Guide Me Clients.

* First name

* Last name

Address

* Emergency contact

* Phone

GP Name and Surgery

* All Medical Conditions

* Any Formal Psychological Diagnosis

* Any Suspected, but Undiagnosed Conditions

What would you like me to know before our first session?

* Email

* Please print your name here to confirm that all the above info is correct

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Stay Connected with Janette & Dragonfly Parenting

Location: Based in Hertford, Hertfordshire (Home visits available locally)

Sessions Available: Online via Zoom & WhatsApp

Contact: 07527 577987 (Text or Call)

Email: yougrowwithjanette@gmail.com (Please check your junk folder for replies)

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