Weight Loss Questionnaire How did you hear about us? (please check ALL that apply)
Are you currently under the care of a physician?
Did your doctor recommend that you use hypnosis?
Do you have any dietary restrictions?
Have you ever been diagnosed with epilepsy or had seizures of any kind?
Did you know that hypnosis is 100% safe?
Have you ever been hypnotized before?
Does your weight problem make you physically uncomfortable?
Do you believe weight loss has to be painful?
Do you suffer from uncontrollable cravings?
Do you feel food controls you?
Do you eat because of emotions?
Do you eat between meals?
Is successful weight loss a top priority?
Will you purchase a new wardrobe when you lose weight?
Do you believe weight loss can be fun and enjoyable?
Do you feel your eating behavior is normal?
Does your family support your weight loss efforts?
Is your family excited about your weight loss with hypnosis?
Can you remember being your ideal weight?
What is the most important element in deciding to use our services?
SUBMIT
