Questionnaire

Please take the time to fill in my short questionnaire below.

Name:
Contact number:
Best time of day for me to contact you:
Email address:
Area where you live:
How did you hear of me?
What is the issue you would like to resolve?
How does it affect your life?
Where you would like to see me	Cobham Central London
Are you interested in:	5-PATH Hypnotherapy 7th Path Self Hypnosis Past Life Regression

Address

You can book appointments to see Niki Cassar at the following locations.

The Integrated Medical Centre, 43 New Cavendish Street, London W1G 9TH

The Life Healing Partnership, Willow Cottage Studio, Hooks Corner, Old Common Road, Cobham, Surrey KT11 1JP