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Jaiye Dania, Hypnotherapist & Professional Health Coach

Rapid Transformational Therapy™ Practitioner

Emotional and Peak Performance Specialist

New Client? Click Here >

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Intake Form

Personal Details

Health

Health Problems

From the list below, check your areas of concern:

Addictions

Drinking

Smoking

Drugs

Gambling Compulsive Behavior

Anxiety Stress

Fears Phobias

Panic Attacks

Guilt

Relaxation

Eating Problems

Food / Diet Weight

Problems Anorexia

Bulemia Excerise

Depression

Self Confidence

Esteem

Motivation

Acheiving Goals

Procrastination

Career Issues

Interview Skills

Nerves

Public Speaking

Concentration

Exams Memory

Driving Skills

Sexual Problems

Fertility

IVF Conception

Pregnancy Birth

Pain Control

Hearing, Sight / Vision Mobility

Skin Problems

Hair Growth

Relationships

Childhood Problems

Sleep Problems

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Contact Me

Jaiye Dania, Hypnotherapist & Professional Health Coach

Rapid Transformational Therapy™ Practitioner

Emotional and Peak Performance Specialist

For any questions you have, you can reach me here:

jaiyedania@gmail.com

New Client? Click Here >

Thanks for submitting!

Professional Health Coach | Hypnotherapist | Peak Performance Specialist

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