SCOTTISH SCHOOL OF HYPNOTHERAPY LTD

Practitioner Course in Clinical Hypnotherapy
Start date of course for which applying
   
Mr/Mrs/Miss/Ms/Other
SURNAME
FORENAME
DATE OF BIRTH 00/00/0000
ADDRESS
POSTCODE
TEL. NO.
MOBILE NO
EMAIL(if applic)
PRESENT OCCUPATION
PREVIOUS OCCUPATIONS
QUALIFICATIONS
FURTHER DETAILS (if desired)
   
ANY PREVIOUS HYPNOTHERAPY EXPERIENCE (if relevant)
   
REASONS FOR WANTING TO ENROL (career/general interest/self-development etc)
   
HAVE YOU EVER BEEN TREATED FOR A NERVOUS DISORDER Yes No
(If YES, please give brief details)
   
DO YOU/HAVE YOU EVER SUFFERED FROM EPILEPSY? Yes No
(If YES, please give date of last seizure)
   
PLEASE INDICATE ANY OTHER MEDICALPROBLEMS/DISABILITIES
   
ANY SPECIAL DIETARY REQUIREMENTS? Yes No
(If YES, please detail)
   
WHAT ATTRIBUTES DO YOU POSSESS WHICH YOU CONSIDER WOULD CONTRIBUTE TO:
THE COURSE ITSELF:
WHAT ATTRIBUTES DO YOU THINK WOULD MAKE YOU A GOOD HYPNOTHERAPIST (Were you to choose to practise
   
HOW DID YOU HEAR ABOUT THIS COURSE?
   
NAME & ADDRESS OF TWO REFEREES  
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Note – Partners are discouraged from attending together on the same course as this can havean inhibiting effect on the development of the individual. This is partly due to the nature of the course and partly because of the student may encounter resistance during the practice of hypnoanalytical techniques in week two of the course.



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