Child Story Form
Parent's Name
First Name
Last Name
Best Phone Number (In Case of Additional Questions)
Please enter a valid phone number.
Child Gender
Please Select
Boy
Girl
Prefer not to say
What specific challenge would you like to address for your child?
For how long has this problem/concern been an issue?
What specific problems and feelings has having these challenges created for your child?
What positive changes would making these changes do for your child?
What positive feelings and benefits would moving through this challenge create for your child?
Is there anything about this challenge that you feel it would be helpful for the hypnotist to know that could help?
Child's favorite shows, characters, etc... (anything included would be helpful).
Does your child have a favorite color? If so, what is it?
What hobbies and interests does your child have?
Please add anything else you think would be beneficial to know for your child's story?
Note: Each story is created specifically for your child, and may take several days to create. Once the stories have been created for you, you will receive an email with your stories. If you have any questions or concerns, please reach out to Nicole at hypnoticwellnessmethods@hotmail.com.
Submit
Should be Empty: