What is Hypnosis Used For?
Initial Consultation
Blog & Photos
Resources
Set Appointment
Menu
What is Hypnosis Used For?
Initial Consultation
Blog & Photos
Resources
Set Appointment
Hypnosis
&
Issues
Initial Consultation
Video Blog
& Photos
Resources
Schedule
Appointment
Click to Schedule Your Appointment
or Call 952-934-1315 today!
Smoking/chewing Questionnaire
Name
Did your parents smoke/chew?
Does your spouse/significant other smoke? Do your children smoke?
How old were you when you had your first cigarette? What were the circumstances surrounding it?
Did you continue smoking from that point? If not, when and why did you start again?
Why do you smoke? What benefits do you get from it?
What do you fear if you stop smoking?
What are 5 benefits you’d get if you stopped smoking?
How many times have you tried to stop smoking? If so, what is the longest period of time that you have stopped?
What was your level of commitment when you tried to stop on a scale of 0 to 10(10 being best effort)?
Why did you to start smoking again?
What has been your greatest challenge when you have attempted to quit smoking in the past?
Why are you choosing to stop smoking now?
What is your level of commitment now (scale of 0 to 10)?
Is it your intention to stop smoking today? If not, why?
Send
7760 France Avenue South #1163 Bloomington, MN 55345
Search for:
© 2013-Present
Facebook
Schedule Your Appointment
or Call 952-934-1315