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To order your pre-recorded or personal tape or cd by post along with payment cheque, please print out and post this form. For a personal tape or cd, please answer as many of the questions as possible.
Your Name......................................................................................... Your Address...................................................................................... .......................................................................................................... .......................................................................................................... I'd like to order a pre-recorded tape (£10.00 plus £1.00 p&p) or cd (£14.00 plus £1.00 p&p) to help me with: .......................................................................................................... Or, I'd like to order a personal tape (£25.00 plus £1.00 p&p) or cd (£29.00 plus £1.00 p&p) First name by which you like to be called?.............................................. A brief description of your problem or need....................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... Age at which you first discovered this .. From the following list, which place, are you drawn to most? Beach <> Desert Island <> Space <> Mountain <> Waterfall <> Cottage Garden <> Forest <> Lake List below anything that you may feel relevant. With phobias it is sometimes helpful to give the 2 or 3 most worrying things that you feel with your particular phobia. This will help me to understand at what level I need to pitch the hypnotherapy. For instance: Scared of the dentist, you may be terrified at the very thought of picking up the telephone to make the appointment, or it may be the thought of having an injection. For heights you may be terrified of the 1st rung of a ladder, or you may not like a rooftop, or a bridge. If you require a confidence boost it could be in a specific area such as exams, stage fright or public speaking. Sometimes just a standard confidence boost could be all you need! .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... If you have any person very close to you a relative or friend that you feel might be a positive influence please give me their name and any comments that you may think relevant. If none leave blank or write none. .................................................................................................................................................... Please list a few things that you enjoy doing away from worrying about your problem, things that make you relax maybe, hobbies or even ambitions can be included. It could even be something you used to do that you feel you would like to do again. Any positive comments are helpful. .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... Its makes it quite difficult to record anything without these positive points, they are very important. I enclose a cheque for ............... made payable to Paul Hughes Send to: Paul Hughes 7 Teeling Road Weymouth DT3 5JT Tel 01305 750736 |