1. The Problem
  2. Medical History
  3. Other Information
  4. Add to Basket
  5. Make Payment

Personalised Therapy CD

Please fill in the following form to order your personalised therapy CD. The more honest and detailed your answers are, the more effective your CD should be. Your details will be submitted over a secure server.

Personal Details

Your Full Name

Age

Married/Partner

I have had hypnosis before

The Problem

What are your symptoms?

How long have you been suffering for?

How severe are your symptoms?
Very Mild | Mild | Severe | Very Severe

How were you before these thoughts started?

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