Client Information Form

Full Name:

Email address:

Phone number:

Date of birth:

Address Line 1:

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City/Suburb:

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When did you have your last medical check-up?

Are you currently taking any medication?

If yes to the above, could you elaborate a little on what and why you are taking these?

Tick any areas that concern you:

Is there anything else you think I should know?

What is the ONE MOST IMPORTANT challenge that you want to focus on for this session?

Why do you think you have this issue?

What is the one question you could ask that would give you the answer you most want to know about this challenge?

If I could wave a magic wand what one thing would ask for in relation to this issue?

If you no longer struggled with this, how would it impact your life? Be as specific as you can include all senses where possible. The words and phrases you use will have a major impact on the new beliefs we will create.

Have you worked with an RTT therapist in the past on this issue? If yes, what was your result?

Are you committed to your results and your journey? Will you invest in yourself and listen to the recording as required andtake action on any suggestions etc.?

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Transform Your Life

Client Information Form