Personalised hypnotherapy form for Bad Habits.

Bad habits personalised mp3 order form

Please fill in the form below to start your order for a tailored and personalised hypnosis mp3 to help you overcome your bad habit. I might contact you by email if I have any questions for you before I make your mp3. If you prefer me not to do this please indicate so in the last box f this form.

Bad habit personalised mp3 form

Name

Email Address

Select your age

Your Phone number (Optional)

select your gender

Select time you have suffered from your bad habit

Please tell me about your first memory of your habit

Is there any particular time when your habit is most uncontrollable? If yes please tell me about it.

Do you suffer from any allergies? If yes please give details.

Do you take any mind altering medication? If yes please give details

Please tell me in your own words and as much detail as possible about your habit and how it makes you feel. Including anything you may think is relevant no matter how silly it may sound.Message