Take a survey - Intentional Hynopsis

Initial Assessment

Thank you for considering Intentional Mind and Wellness Hypnosis. Please complete this short questionnaire so we can better understand your needs and help guide and support you.

Country of origin

What type of hypnosis are you seeking inquiry for?

Lose Weight Anxiety and Stress Stop Smoking/Vaping Chronic Pain Management Depression Fears and Phobia Anger Issue Self-Esteem Personal/Family Challenges Insomnia/Bad Dreams Improve Relationships Athletic Performance Abuse and Trauma Social Anxiety Virtual Gastric Bypass for Weight Loss Hair Pulling/trichotillomania Sports Bed wetting Stop Gambling Alcohol Abuse Boost Immune System Concentration and Focus Fear of Flight Fear of Height Fear of Dental Procedure High Blood Pressure Irritable Bowel Syndrom (IBS) Loss and Separation Migraine Motivation Nail Biting Procrastination Sexual Issues Speaking in Public Test Anxiety And more, call for discussion Other

Where are you currently located?

Baltimore Outside Baltimore

Are you applying for yourself or on behalf of someone else?

Myself My spouse / partner My child / children A family member My business / as an employer Other

What type of appointment do you want?

Phone Video Physical A combination of either Not sure

How soon do you need a hypnotherapy?

Immediately Within 1 month Within 1–3 months Within 3–6 months No specific deadline yet Not sure

Would you like an initial assessment of your case?

Yes, please contact me Yes, but only by email Not yet, just browsing information No thank you

What is the best way to contact you?

Phone call WhatsApp Email Any method is fine

Any additional comments?

'Want to Get Started?

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Technopole Building (Next to Travel Lodge), Kingston Crescent, North End. Baltimore, United States of America

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Take Initial Assessment
Questions & Answers
Contact me

Home
About
Services
Take Initial Assessment
Questions & Answers
Contact me

Book Appointment