Information Package

Intake Form

Please complete this form before the appointment.
Once finished this step come back and download remaining forms to be completed for your session.
Make sure you click the link at the bottom of the page so you can listen to the two audios. The first one explains the process and can be listened to when driving or working. The second one is hypnosis, so listen to this in a quite space possible before going to sleep. It is very relaxing.

Complete Form

Confidential Information

Please download and print this form. Complete and sign this form and bring to your appointment.

Confidential Personal Information

Terms of Acceptance

Please download and print this form. Complete and sign this form and bring to your appointment.

Terms of Acceptance – disclaimer

Times You Smoke and Reasons For Quitting

Please download and print this form. Complete and sign this form and bring to your appointment.

Quit Smoking Times and Reasons

Ideas To Replace Cigarette Smoking

Please download, print, add your ideas and bring to your appointment.

Download Ideas To Replace Cigarette Smoking Document

Pre-Session Action Plan

Please read this document before your appointment, making sure you follow the links it contains. Keep for reference later.

Pre Session Action Plan

DASS Assessment Form

People often use cigarettes act like a crutch for them. Letting them go can cause a release of emotional challenges. So it is important we capture those areas and are aware of them prior to quitting smoking so they can be addressed.  Fill out this form and bring it in with you when you come for your session.

Download DASS Assessment Form

NOTE:- Listen to these two Audios

The first one is an actual stress relief self-hypnosis and an introduction to hypnosis that is fun and informative. You can listen to the first track in the car or when you are doing your work. However for the second audio will require you to a quiet space where you can relax and enjoy the experience of hypnosis. Please ensure listen to it the night before your session and have a good night’s sleep.

Listen to the two audios on the website