Have you ever been in Hypnosis before? *

      Yes

      No

What is the main OUTCOME you are looking to create? Be as specific as possible. i.e. How much? By When? *

Why do you want this? *

Write a Short Story about your New Life after this outcome has already been achieved *

Create FIVE sentence, stated in Present Tense regarding the Positive Benefits/Feelings you will have as a result of achieving this goal. *

What are the positive feelings you will have once you have achieved this goal?

     Alive

     Delighted

     Proud

     Calm

     Excited

     Relieved

     Capable

     Strong

     Confident

     Happy

     Content

     Hopeful

     Courageous

     Lovable

     Other

Create 10 Positive Personal Affirmations about this Goal *

Why and How badly do you want this change? *

List anything you have done that is already working for you *

Do you prefer background music? *

     Yes

     No

Would you like your name mentioned? *

     Yes

     No

How long would you like this to be? *

     15 Min

     20 Min

     25 Min

     30 Min

How Long of an induction would you like? (The part where I'm getting you into hypnosis.) *

     2 Min

     5 Min

     8 Min

     10 Min

List any additional information you want to include. *