Have you practiced Meditation or Hypnosis/Hypnotherapy/Self-Hypnosis before and if so was it successful?

On a Scale of 1-10 ... 10 being the most stressful, how stressed do you feel?

Please list anything that currently bothers you. Stress, sleep or anything else.

Why do you want to learn how to meditate?

What goal specifically do you wish to achieve? What do you feel is blocking your progress?

On a Scale of 1-10 ... 10 being the most kind, how kind are you to yourself?

What's ONE thing you must STOP doing in order to take your life to the next level?

What does the term, LETTING GO, mean to you?

Are you a person who follows instructions easily?

On a scale of 1 to Bruce Lee, how awesome are you?

Name

Email Address

Occupation

City and Country

Mobile/Cell Phone