Clinical hypnotherapy referral

Consent: You consent to be contacted by a member of Dental Sedation Solutions to book your initial consultation with Dr Munir Ravalia.
Complete Referral Form: Fill out all required fields on the referral form comprehensively. Provide detailed information about your condition, treatment history, and concerns you hope hypnotherapy will address.
Patient History: Include a comprehensive summary of your medical and dental history, including any relevant psychological or emotional factors that might affect the effectiveness of hypnotherapy.
Current Treatment Details: Provide information on any current treatments or therapies you are undergoing any previous interventions related to your condition.
Specific Goals: Clearly outline the goals you hope to achieve through hypnotherapy, such as reducing anxiety, managing pain, or improving relaxation during dental procedures.
Relevant Documentation: Attach any relevant documentation, such as previous assessments, test results, or notes from other healthcare providers, which may help the hypnotherapist understand your needs better.
Contact Information: Ensure your contact details are accurate so our team can reach you for any follow-up questions or additional information.