Application to work with The Black Hypnotist

Hi There

Thanks for stopping by!

Please complete the form below and be as specific and detailed as possible. I’ll review your information personally and you’ll be contacted within 2-3 business days to determine whether or not working with me is a good fit for you. If so, the next step will be to schedule a time for an initial consultation.

All information provided is completely confidential, is seen only by yours truly, and will not be shared with a third party under any circumstances.

NOTE: Applications that are filled out hastily are not guaranteed to receive a response. Please take the time to be thorough with your answers.

Thank you!

First Name

Last Name

Phone

What would you like to work on with your hypnotherapist? Please list topics in order of importance. List as many areas of improvement as you would like. Your hypnotherapist will review them with you in your first session.

Do you have any questions about your upcoming hypnotherapy sessions? You can share them here and your hypnotherapist will address them with you during your first session.

Please let us know if you have any strong religious, spiritual beliefs you’d like us to be cognizant of? We always follow your lead as far as making sure that your sessions are in alignment with your worldview and beliefs.

How did you find us?

Application to work with The Black Hypnotist

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