Are You Ready To Surrender Your Mind?

Please fill out the form honestly and to the best of your ability.

The information you provide is for my consideration for the purpose of hypnosis only.

Fields marked • are required.

• Name • Email • Country where you are based Have you been hypnotised before? • What type of hypnosis do you require? • What would you like hypnosis to achieve? • Do you have any fears / phobias? • Do you suffer from respiratory problems (e.g. asthma, chronic sinusitis, allergies, COPD etc)? • Do you suffer from epilepsy or other seizures? Have you ever suffered from depression? • Have you ever had treatment from a psychologist/psychiatrist/therapist ? • Are you currently taking any medication (please state): Are you interested in • What is your availability (UK time)?

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