LLE Bespoke Hypnosis Audio Application

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
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Please provide your city and state (U.S.) or city and country (outside U.S.)* This field is required.
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What do you for for work?* This field is required.Please be specific
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What is your biggest mental block that's preventing you from reaching your next level now?* This field is required.Please be specific
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What would you like to achieve through this hypnosis audio?* This field is required.Please be specific
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Why do you feel this hypnosis audio is critical for your current stage of business or life? How would it change your business and life over the next 3 months?* This field is required.Please be specific
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What has been your past experience with hypnotherapy, and what did you like/dislike about it?* This field is required.Please be specific
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On a scale of 1–5 (1 being the lowest and 5 being the highest), how much accountability do you take for your results?* This field is required.
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I understand Tarla Makaeff is not a licensed physician, psychologist, or medical practitioner and that hypnotherapy should not be considered a replacement for the advice and/or services of a psychiatrist, psychologist, psychotherapist, or doctor.* This field is required.
I acknowledge I agree to these terms
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Are you currently under the care of a psychiatrist, psychologist, psychotherapist, doctor, or other healthcare provider, and if so for what issue? Are you taking any prescribed medication, and if so what medication? (All information provided is protected by strict confidentiality.)* This field is required.Please be specific
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Are you taking ketamine, psychedelics, plant medicines, nootropics, or other mind-altering substances? (All information provided is protected by strict confidentiality.)* This field is required.
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No
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Only people with sound mental health who are confident that a review of past events will not adversely impact their emotional or mental health should participate in root cause hypnotherapy or hypnotherapy. You acknowledge that neither you nor your treating practitioners have any past or existing concerns about your mental health.* This field is required.
I acknowledge I agree to these terms
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Hypnotherapy is not advisable w/ epilepsy; narcolepsy; schizophrenia; schizoaffective disorder; psychosis; alcohol/drug abuse; hallucinations; dementia; dissociative, personality, bipolar disorders; narcissism; suicidal ideation; heart conditions; pregnancy* This field is required.
I understand hypnotherapy may exacerbate the symptoms of these particular conditions, and I confirm that I do not have any of these conditions nor am I pregnant
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Are you ready to invest $555 today for lifetime access to a bespoke hypnosis recording that can shift your identity?* This field is required.
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