Thank you for investing in your Personalised Hypnosis

Please fill out this form to help me create a personalised hypnotherapy recording tailored to your needs. Your responses will remain confidential and will be used solely for this purpose.

Personal Information

First name

Last name

Phone

Note: If this recording is a gift for someone else, please indicate here and provide their name:

About Your Riding and Horsey Experience

What do you enjoy doing with your horse?

How would you describe your personal horsey background and experience?

There must have been a reason you decided to go for it and get a personalised hypnosis recording—what was that reason?

If I could wave a magic wand and your riding, experience, and time with your horse were just the way you hoped, how would you describe it?

In your opinion, what’s currently stopping you from having the above right now?

Have you experienced any past events or incidents (e.g., a fall, injury, or bad experience) that may have contributed to your fears? (If yes please describe briefly)

Understanding Your Challenges

When you feel nervous, how does this manifest for you personally? (Examples: racing thoughts, physiological symptoms like a tight chest, or overthinking.)

Thinking about your relationship with your horse, how do you feel your energy influences your time together? (What energy do you feel you need to bring? E.g., relaxation, focus, motivation, grit, calm.)

Are there any specific affirmations, phrases, or words that resonate with you? (Examples: "I am capable," "I trust myself and my horse.")

How will you know you’ve made progress or overcome your challenges? (What changes will you notice in yourself or your riding?)

Health and Background Information

Have you ever used hypnotherapy before? If yes, what was your experience like?

Do you have any medical conditions (e.g., epilepsy) or mental health concerns we should be aware of? (Note: Hypnotherapy is not a substitute for medical treatment. Please consult a professional if unsure.)

Are you currently working with a coach, therapist, or other professional on confidence or anxiety issues?

Consent and Agreement

Do you give consent for me to use the information provided to create a personalised hypnotherapy recording for you?

Yes

Additional Notes

Is there anything else you’d like to share about your riding or goals that would help me personalise your recording?