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Self-Esteem Workshop
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Ultimate Weight Loss Power Pack
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The Six Essential Laws of Winning in Life
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HypnoSexual Tool Box for Men MP3
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Super Hypnotic-O DVD
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Custom Hypnosis CD form
Custom CD
Custom CD Questionaire
1.*Name
2.*Phone Number
3.*e-mail address
4.*Have you ever been in hypnosis before?
Yes
No
5.*What
is the main OUTCOME you are looking to create? Be as specific as to how much
more
you want, when, how, WHY?
6.*Which do you consider yourself more of?
Auditory? (Responsive to sound)
Visual? (Responsive to images)
Kinestetic? (Responsive to feelings/touch)
7.*How does the problem affect you now?
8.*Please write a SHORT STORY (several paragraphs) about your NEW LIFE after this outcome has already been achieived.
9.*Please create FIVE sentences. Stated in Present Tense regarding the positive benefits/feelings you will have as a result of achieving this goal?
EXAMPLE:
I have more time for myself. or I am falling back in love with life and myself again.
10.*What are the positive feelings you will have once you have achieved this goal? (Choose 5 - 10)
Alive
Delighted
Proud
Calm
Excited
Relieved
Capable
Strong
Confident
Happy
Content
Hopeful
Courageous
Lovable
Other
11.*
CREATE
10 POSITIVE PERSONAL AFFIRMATIONS ABOUT THIS GOAL
.
Positive affirmations can come in the form of positive statements, usually short sentences, which aim to challenge the negative beliefs you have about yourself. I.E. Change "I am Fat" to "I am ready and willing to be thin. Or Change "I am poor" to "I am in the process of creating large sums of money"
12.Why
and how badly do you want this change?
13.
Please list anything you have already done that is working for you toward achieving this goal.
14.*Title of CD
15.*Would you prefer background music?
Yes
No
16.Anything else you'd like to tell us?
You can continue personalizing here if you still feel there is more to say about your situation. Please try and only speak toward the postive intention you wish to create and not about the drama or story about your past that you are trying to get away from. You can also mention any people, places, names, you want us to mention in the program or any other personalizations you would like to see here.
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