NEW v2 - Mike Smarr, C.HYP, RTT, RTTA - Discovery Call Questionnaire For Initial Consultation

Mike Smarr, C.HYP, RTT, RTTA - Discovery Call Questionnaire For Initial Consultation
Personal & Health Questions
Preferred First Name:*
Age:*
Do You Have Any Past Or Present Medical Conditions Or Health Issues?*

YESNO
Are You Currently Taking Any Medications Or Supplements?*

YESNO
Do You Have A History Of Psychiatric Illness?*

YESNO
Do You Have A History Of Epilepsy?*

YESNO
Do You Have, Or Have You Ever Had, Suicidal Thoughts?*

YESNO
*CAUTION:

People diagnosed with Epilepsy and/or a psychotic illness are generally advised not to enter hypnosis.
Please Select Your Areas Of Concern From The List Below:
AddictionsDrinkingSmokingDrugsGamblingCompulsive Behavior
AnxietyStressFearsPhobiasPanic AttacksGuiltRelaxation
Eating ProblemsFood/DietWeight ProblemsAnorexiaBulimiaExercise
DepressionConfidenceSelf-EsteemMotivationAchieving GoalsProcrastination
Career IssuesInterview SkillsNervesPublic SpeakingConcentrationExamsMemoryDriving SkillsNail Biting
Sexual ProblemsFertilityIVFConceptionPregnancyBirth
Pain ControlHearingSight/VisionMobilitySkin ProblemsHair Growth
RelationshipsChildhood ProblemsSleep Problems
What Is It That You Would Like To Achieve From This RTT Session?*
How Does Achieving This Change Your Life?*
What Does Your Life Look Like Without The Issue(s) You Mentioned? (Take a moment to imagine, and then describe in as much detail as you would like)*
What Must Be In Place To Support You In Making The Desired Changes For Your Health?*
On A Scale Of 1 - 10, With 10 Being The Greatest, How Motivated Are You To Do The Work Required To Really Transform Yourself And Your Life?*
*A Few Rules Of The Mind That Will Be Beneficial To You:

1.) Your Thoughts Form A Blueprint That Your Mind And Body Work To Make Your Reality

2.) Your Mind Does Not Care If What You Say Is Good, Bad, Indifferent, True, False, Healthy, Unhealthy, Right or Wrong - It Simply Acts On Your Words Regardless

3.) Every Thought You Think Causes A Physical Reaction And An Emotional Response

One Last Thing, I Ask You To Take A Moment To Honor Yourself For Making This Commitment To Change Your Life. You Deserve This.

Thank You For Your Time.

I Look Forward To Speaking With You.

Take Care,

- Mike
Upon Submitting This Intake Form, You Are Consenting To The Privacy Policy Posted At This Link For Your Review. - https://mikesmarr.com/privacy-policy/
Do You Consent To The Privacy Policy That Is Linked Above And Posted For Your Review?*

I Consent
If Your Answers Are Complete, Please Verify That You Are Human And Press The Submit Button Now.
Please Verify That You Are Human*
*After The Discovery Call Questionnaire Form Is Completed And Submitted, You Will Either Be Redirected To The Discovery Call Booking Link Immediately, Or You Will Personally Receive A Link In Your Email, Or Through Direct Messaging Or Text, Within 24 Hours. - Thank You For Your Time.
Should be Empty:

Mike Smarr, C.HYP, RTT, RTTA - Discovery Call Questionnaire For Initial Consultation

Personal & Health Questions

Please Select Your Areas Of Concern From The List Below:

*After The Discovery Call Questionnaire Form Is Completed And Submitted, You Will Either Be Redirected To The Discovery Call Booking Link Immediately, Or You Will Personally Receive A Link In Your Email, Or Through Direct Messaging Or Text, Within 24 Hours. - Thank You For Your Time.