Book Online

Congratulations! Looks like you are ready to Break Your Cycle and take the next steps towards living your life without limitations!

Our Coaches, Psychotherapists and Clinical Hypnotherapists are here to help you. Get connected with a Therapist near you.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Phone Number *

Date of Birth *

Street Address *

Suburb *

State *

Post Code *

I am completing the form for… *MyselfOn behalf of someone else

If completing the form on behalf of someone else, please describe the circumstances.

What Service Would You Like to Access? *Strategic CoachingGordian PsychotherapyClinical Hypnotherapy

Are you taking any Medication? *YesNo

If Yes, please list any Medications you are taking?

Are you currently under the care of another Therapist? *YesNo

If Yes, please describe any other therapy you receive

Have you had Hypnotherapy before? *YesNo

If yes, please describe your previous Hypnotherapy experience

Describe your Alcohol Consumption *I don't drink at allI drink OccasionallyI drink SociallyA glass or two a nightEveryday ConsumptionI use it to help me sleep

Describe the Quality of your SleepPoorAverageVariableGood

Have you ever suffered from any of the following? *

• Depression
• Anxiety
• Phobias
• Addiction
• Chronic Insomnia
• Compulsive Disorders
• Drug Abuse
• Eating Disorder
• Bipolar Disorder
• Schizophrenia
• None of the above

Describe any other Mental Health History

Do you suffer from any of the following? *

• High Blood Pressure
• Respiratory Problems
• Back or Neck Pain
• Digestive Issues
• Dizziness/Fainting
• Psoriasis/Skin Complaints
• Autoimmune Conditions
• None of the above

Describe any other Past Medical History

What do you hope we can help you with? *

• Performance Anxiety
• General Anxiety
• Social Anxiety
• Work Stress
• Burnout
• Stop Smoking/Vaping
• Stop Drinking
• Low Self-Esteem
• Procrastination
• Anger
• Weight Management
• Addiction
• Pain Management
• Trauma/Post-Traumatic Stress
• More than of the above

Are you a member of a Health Fund? *YesNo

Please Note: Health fund rebates vary between funds and levels of cover. Additionally, changes in policy can occur at any time. We cannot tell you if your particular insurance policy will cover your hypnotherapy sessions, or what your rebate will be.

Which Health Fund are you with?

How do you prefer your Sessions to be Delivered? *OnlineIn-person

How did you find out about That Health Hub? *Google SearchSocial MediaDoctor's ReferralWord of MouthFriendOther

Preferred Day to Call *

• Weekdays
• Weekends

Preferred Time to Call *

• Mornings
• Afternoons
• Evenings

Cancellation Policy *I AgreeI Disagree

I acknowledge that, unless I give 24 hours notice of a session cancellation, I may be charged in full.

Disclosure *I AgreeI Disagree

I understand that if I disclose that I have or intend to commit certain criminal offences, our Therapists are required by law to report this to the authorities.

Disclaimer *I AgreeI Disagree

I also recognise that I am seeking alternative/non-medical treatment that may not be supported or endorsed by established medical practice.

Consent *I ConsentI Do Not Consent

Do you consent to the use of Coaching, Psychotherapy or Clinical Hypnosis as a treatment tool during your sessions?

Acknowledgement *YesNo

I acknowledge that the information I provided is true and correct.

Is there anything else you think we should know?

Please provide any other information you feel may be relevant

Book Now