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First Name: |
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Last Name: |
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Gender: |
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Age: |
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Mobile Phone: |
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Email: |
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Email confirm: |
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Suburb: |
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State: |
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Country: |
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Current Primary Occupation: |
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TRAINING: |
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Please state any Hypnosis, NLP and any therapy training that you have: |
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Length of Training?: |
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How long ago did you graduate the training??: |
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PRESENT STATE: |
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How do you feel now as a therapist?: |
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What are the questions and issues you have as a therapist?: |
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How many clients a week do you see?: |
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YOUR DESIRED OUTCOME FOR SUPERVISION: |
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What would you like to achieve in supervision, and as a therapist?: |
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How would you like to feel/ behave /see yourself as a therapist?: |
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Can I add you to my mailing list for updates? |
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Terms and Conditions |
Please read carefully |
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