QUESTIONNAIRE/INTAKE FORM 

Before your first hypnosis session is to begin, you are required to complete our Questionnaire/Intake form.  If you are coming in for our Stop Smoking Program, please complete only the Stop Smoking Intake form.  If you are not coming in for smoking cessation, please use the "General Intake Form".  

You may show up 15 minutes prior to your appointment to complete this form, or you may choose to download the appropriate MS Word document and complete it at your leisure.  If you are choosing to complete the downloaded form prior to attending your session, remember to bring the completed form with you and please arrive 5 minutes before your scheduled appointment time.  Thank you.

Stop Smoking Brochure

Side 1 and Side 2 are separate documents.  Be sure to print both sides.

Reproduction and distribution is encouraged, provided that you do not alter the content in any way shape or form.  The intent is to help as many people as possible to stop smoking.  Our mission is to improve people's health and perhaps even save their lives.  Please do share!  Thank you.

 Stop Smoking Poster

For your office bulletin board.  For public places.  Share the gift of health with everyone!