x

Custom Hypnosis CD Form

customCustom Hypnosis CD Form

Custom CD Questionnaire



(required)

(required)

(required)
(required)
Yes  
No  

(required)
(required)
Auditory? (Responsive to sound)
Visual? (Responsive to images)
Kinestetic? (Responsive to feelings/touch)

(required)

(required)

(required)
(required)
Alive
Delighted
Proud
Calm
Excited
Relieved
Capable
Strong
Confident
Happy
Content
Hopeful
Courageous
Lovable
Other

(required)

(required)

(required)

(required)
(required)
Yes  
No  

(required)