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 Benefits Form

Thank you for choosing the NY Hypnosis & Laser Center.
Please fill out this form. The information will be helpful during your session.

Benefits of making the change you want

e-mail:
First Name:
Last Name:

List seven of the benefits you expect to gain from making the change you would like to make.

1.
2.
3.
4.
5.
6.
7.

I often feel that I should be punished for something I once did.
I know of an experience or relationship that could be causing this problem.
I am aware of an internal conflict that may be causing part (or all) of my problem.
If I get better, I stand to lose:   
If I were't so much like...     I'd be much happier.

If you have any questions about this form or hypnosis, please note them here"
       

NY Hypnosis & Laser Center
is The Personal Change Place.  Tell your friends.

© 2003 NY Hypnosis & Laser Center
4160 S. Ft. Apache Road-Ste B
(within Madame Et Monsieur)
Las Vegas, NV 89147

Tel: 702-454-7910  Fax: 702-507-2335