Can I Be Hypnotized?

Name*

Email*

Cell Phone: *

I find it easy to relax: Yes, Sometimes, No*

I use my imagination to picture objects, people or situations: Yes, Sometimes, No*

I remember my dreams, or parts of my dreams: Yes, Sometimes, No*

I set goals for my future: Yes, Sometimes, No*

When watching my favorite TV show or movie, I can relate to a character or "get lost" in the show: Yes, Sometimes, No*

When driving a familiar road, I have arrived safely at my destination without remembering every turn of the drive: Yes, Sometimes, No*

I look forward to making changes in my life to live more fully and happily: Yes, No*

I'm curious about how hypnosis can help me create the changes I desire: Yes, No*

I would want to be hypnotized for: *

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