Customized Hypnosis Questionnaire

Name *

First

Last

Email *

Email

Confirm Email

Phone *

Gender *

1. Have you ever experienced hypnosis? *

If yes, please explain.

2. Describe the goal you would like to achieve, or the obstacle to overcome. *

3. What has been stopping you or holding you back from achieving your goal? *

4. What do you need to believe is true about yourself to achieve this goal? *

For example - creative, capable, intelligent, good enough, worthy, etc.

5. What is the most important action you need to take to achieve your goal? *

This needs to be a physical action step.

6. What thought would help you accomplish this action step? *

7. What feeling would help you accomplish this action step? *

For example - energized, happy, or powerful.

8a. Describe what it is like to actually be doing the action step. *

8b. How do you feel doing this action step? *

9. Describe what happens when you achieve your goal. *

If other, please explain.

11. What do you want to name your audio recording? *

Create a title.

12. Would you like background music? *

13. Would you like your audio recorded by a man or woman? *

Man's voice: Mr. Adrian Rusin | Woman's voice: Ms. Amanda Bell | Both Certified Medical Support Hypnotherapists

14. Anything else you'd like to tell us? If there is anything else you would like to say about reaching your goal, please write it here. You can mention names of people and places that you would like to hear in your recording.

Keep your words positive as this is the first step towards success.

Hypnosis Questionnaire

To create your personalized hypnosis audios, kindly take a moment to answer the following questions. Your response will guide us in tailoring the audios to meet your specific needs and goals.