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ORDER FORM
Please fill in the questionnaire below
to order a personalized tape/CD:
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| Marital Status: |
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Desired result of Hypnotherapy:
(In the space below describe what outcomes you desire) |
To further assist in preparing
your personalized tape, please specify the name to be mentioned
on the
tape/CD. |
| Specify any specific goals you would
like stressed: |
| How long have you had this problem? |
| Have you ever undergone hypnotherapy,
psychotherapy, or counseling? |
| Describe your current state of health: |
| Have you ever been hypnotized before? |
| If yes, describe your
experience: |
STRESS KILLS