Client Intake Form

To get the most effective use of our time together, please fill in this form prior to your first session with Blazenka or Nanci.

 

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CLIENT DETAILS

Client Name
Contact Address

EMERGENCY CONTACT INFORMATION

Emergency Contact's Name
Have you ever experienced?
Have you been treated for any of the following?
If Yes, please state medications/drugs.
If Yes, please provide the due date

FINAL STEPS

How Did You Hear About Us?

Client Declaration

I acknowledge understanding all questions and the information that I have given is complete and accurate to the best of my knowledge.

I am willing to be guided through relaxation, visual imagery, creative visualization, hypnosis, coaching and stress reduction processes and techniques for the purpose of self-improvement.

I understand that the hypnotherapy, kinesiology, reiki, past life regression, transference healing & Sound Therapy I am receiving is not a substitute for normal medical care and and am aware that this is not a prescription nor a diagnosis.

I also acknowledge that I have been advised to discuss this hypnotherapy, kinesiology, reiki, past life regression, transference healing & sound therapy with any doctor who is taking care of me now or in the future and that I should continue any present medical treatment and consult my regular medical doctor for treatment of any new or old illnesses.

I understand that my personal information, notes or tapes of my sessions with my practitioner are strictly confidential and cannot be released to anyone without written consent or otherwise as may be required by law.

I understand that any hypnotherapy/past life session will be taped and kept on a secured section of the  practitioner’s computer.

I am fully aware that my success depends on me doing the exercises as instructed by my practitioner.

Client Signature
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What my clients say!

 

Book Blazenka Online

Rosh Dahya

I have been blessed to have experienced a profound and life changing session with Blazenka.. We had a Past lives regression around relationships and Blazenkas gentle, kind and 100% supportive guidance led me back into several lifetimes where the awarenesses and learnings blew my mind. There has been energetic hooks in my field which I never knew were there and deep lessons in foregivness and energetically releasing guilt in my energy field which has been carried through multiple lives and my lineage. After the session I immediately begun to become aware of a lightness and incredible clarity which continues to expand even days after the session. I had no idea there was even a denseness to my energy that I have carried around my whole life until it was released forever. Some of the details of the previous lives that Blazenka had me recall I did some research in Google and the dates etc matched what had come out of me during the session! There have been significant noticeable differences in the way the world is responding to me since the session each day. As I don’t live in Sydney we had the session online and its incredible to know that anyone in the world has the ability to experience a profound life changing session with Blazenka harnessing the power of technology. A lot of people claim to be good at hypnosis, healing & more importantly Past Life Regression. But in my experience as a client in the past, although well intentioned I have found most to be average at best. Past Life Regression is a sacred gift, experience and technique which demands to be treated with utmost respect, care & spiritual integrity. Blazenka embodies this beyond anything and her gift and compassion for her clients exceeds all expectations.I absolutely cannot recommend Blazenka enough 100%.
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Maree Allen – Testimonial

I went to Blazenka due to my weight issues. Although I knew what and when to eat, I needed to overcome my sugar and carb cravings, self-sabotage and the desire to eat constantly, even though I wasn’t hungry. Through a combination of hypnotherapy and kinesiology we were able to identify and address the emotional reasons behind my cravings, self-sabotage and overeating. I enjoyed my sessions with Blazenka very much and was sad when they came to an end. However I know longer crave carbs and sugar and for the first time in my life can happily say no to chocolate. I easily stick to my healthy eating plan and can have the occasional treat without spiralling out of control. Best of all I’m now consistently losing weight easily without dieting and feeling deprived. Another bonus is the recordings of our hypnotherapy sessions which Blazenka tailored specifically to my needs and are now a valuable resource that I can use whenever I need some reinforcement or just to help me stay on track. Blazenka is a beautiful, kind and generous woman who immediately put me at ease. With her warmth, understanding and compassion she is able to provide a safe and nurturing environment for healing. I am extremely grateful for all the help she has given me and would highly recommend her services.

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Di Wood – Testimonial

I love how amazing I feel once I leave Blazenka rooms…. Blazenka records my Hypnotherapy which is fantastic so that I can listen to it again & again when & if I feel the need too…. I have been having regular kinesiology balances to help me with my stress, chronic health & pain management…. I have had some huge shifts in my stress levels & my everyday life…I would recommend Blazenka for any issue big or small Diane xx

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My Space!

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Get in Touch!

Location for Blazenka Sessions

Suite 3, Level 1, Eton Arcade, 754 Old Princes Highway, Sutherland NSW 2232

Location for Nanci Sessions

Suite 3, Level 1, Eton Arcade, 754 Old Princes Highway, Sutherland NSW 2232

Location for Carolyn Sessions

Suite 2, Level 1, Eton Arcade, 754 Old Princes Highway, Sutherland NSW 2232

Phone

0411 286 265

Start your Wellness Journey!