Book your QHHT Session

Your Name (required)

Age (required)

Address (required)

Your Email (required)

Occupation (required)

Marital Status
SingleMarriedDivorced

Telephone Number (required)

How did you find out about me (Tony)? (required)

Have you been hypnotised before? (required)
NoYes

If yes, briefly describe the outcomes of your hypnosis expriences (required)

Briefly describe what your reasons are for wanting to experience a hypnosis session? (required)

It is important to note that pharmaceuticals and various substances, like caffeine, alcohol, psychoactive and hallucinogenic

How often do you use medications such as pain killers, anti-depressants, sleeping tablets, cough medicines etc? (required)
NeverAs RequiredDailyWeeklyMonthly

Do you regularly use any psychoactive/hallucinogenic substances, such as marijuana, cocaine, heroin, etc.? (required)
NoYes

If yes, how often do you use said substances? (required)
DailyWeeklyMonthly

Have you ever had any psychiatric treatment? (required)
NoYes

If yes, please elaborate (required)

Please ensure you Send before completing your booking