Stop Smoking Initial Form

About Your Session

During the session you will be asked about your smoking history and what triggers you to light up. You will also be asked why you want to stop. Many smokers have mixed feelings about quitting but your therapist will work with you to strengthen your commitment to stop smoking.
During the session you will experience Hypnosis, which is a lovely relaxed, day dreamy state of mind. You will be given a number of suggestions and images related to smoking that will stay in your subconscious mind. These images and suggestions work automatically to eliminate or reduce your desire to smoke.
You will also be given some stress management techniques and a number of tips to make the transition to becoming a non-smoker as easy and comfortable as possible.

Full name:

How many cigarettes do you smoke a day?

What triggers do you experience?

Do you drink alcohol?
YesNo

How much & what sort?

Have you had hypnosis or done meditation or yoga before?
YesNo

What would you like to change today?