Personalised hypnotherapy form for Phobias.

Phobia personalised mp3 order form

Please fill in the from below to start you order for a fully tailored hypnotherapy phobia personalised mp3 recording for help to overcome your phobia. I might contact you by if I feel I need more information before I record your session, if you have any objection to this please indicate so in the last box.

Phobia personalised mp3 form

Name

Email Address

Select your age

Your Phone number (Optional)

select your gender

Select time that you have suffered from your phobia

Please tell me about your first memory of your phobia

Is there any particular time when you feel that your phobia is at its worse? 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 phobia and how it makes you feel. Including anything you may think is relevant no matter how silly it may sound.Message