Personalised hypnotherapy form for the fear of the dentist

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Fear of the dentist personalised tailored mp3 order form

Please complete the form below to start you order for a fully personalised hypnotherapy downloadable mp3 for fear of the dentist. It could be necessary that I contact you by email if I have any questions for you before I record your mp3, if you have any objection to this please indicate so in the last box.

Fear of dentist personalised mp3 form

Name

Email Address

Select your age

Your Phone number (Optional)

select your gender

Select time that you have suffered from the fear of the dentist.

Please tell me about your first memory of the fear of the dentist

Is there any particular time when you fear the dentist most? 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 fear of the dentist and how it makes you feel. Including anything you may think is relevant no matter how silly it may sound.Message