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Three Step Rewind Client Questionnaire

Thank you for inviting me to support you with the Three Step Rewind technique. Rewind is a well-established technique which works with our normal human processes to unhook an unwanted emotional or physical response from a difficult experience. Rewind isn’t therapy and I am not a therapist. The purpose of the technique is to unhook the experience from our own innate alarm system. You will retain the memory of the experience, that is very important, but hopefully the difficult feelings that come up around the experience will be eased.

All responses and information shared during our discussions are strictly confidential and all paperwork including this completed form are kept in accordance with GDPR regulations. Please complete and return this form a minimum of 24 hours before your first session to enable me time to prepare for our time together. If you experience any issues with this form, please email me at info@themilkhub.co.uk

You will be asked to confirm the above information again, the day before your appointment. In the event of one or more of the above conditions not being met, a face-to-face appointment will not be able to take place. A virtual appointment will be offered to you at the same time.