Personalised Hypnosis Recording

Information Form

Please fill out the form below so that I have the information that I need to record a hypnosis session that is personalised to YOU. You will then receive this as a YouTube private link within 7 days.

Name (Who you would like to be referred to in the recording)

First Name

Last Name

Do you want your Personalised Recording for:

Quit Smoking

Weight Loss

Reducing Stress & Anxiety

If you ticked yes to Quit Smoking or Weight Loss, what are you mostly addicted to? i.e. cigarettes, cigars, what foods?

When are you most addicted or stressed? e.g. late nights, social situations, while drinking?

What are your main triggers? What causes your stress and anxiety or why do you smoke or eat unhealthy foods?

What is your biggest fear if you DON'T give up smoking, lose weight or ease your stress/anxiety?

What is the main reason for giving up smoking/easing anxiety/losing weight? What is driving you?

What do you want to achieve by giving up smoking/easing anxiety/losing weight? e.g. goals, fitness, set an example for kids, have more money?

How will you feel when you have achieved certain goal?

Is there anything else that you would like to add? Or that you think I would find useful?

Personalised Hypnosis Recording

Information Form

Happy Dreaming