Personalised hypnotherapy form for weight loss.

Weight loss personalised mp3 order form

Please fill in the form below to start your order for a fully tailored and personalised hypnotherapy downloadable mp3 to help you lose weight and maintain that weight loss. I may contact you if I have any questions for you before I record your session, if you have any objection to this please indicate so in the last box.

Weight loss personalised mp3 form

Name

Email Address

Select your age

Your Phone number (Optional)

select your gender

Select how long you have struggled to lose weight.

Is there any particular time when controlling you weight most difficult? 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 as much detail as possible about your struggle to lose weight and how it makes you feel and how difficult it is to control. Including anything you may think is relevant no matter how silly it may sound.