Custom Tape Questionnaire The below questions invite you to think about some 'things' in a much deeper way than you may have before, therefore why not allow yourself some time to be as accurate as possible? Feel free to include anything else that could be relevant on a separate sheet. Post to address given at bottom of this page. You will hear from me personally for additional info via your e-mail address. ---------------------------------- About you. Your name. Full postal address & postcode / Zip. (Print clearly) E-mail address, as further info will be required What name do you prefer being called by? What is your usual or current occupation? How good do you feel about yourself (1-10)? What could make you feel better? Any current stress or worries? (Details) Why choose Hypnosis? Why now and not before? Describe briefly a time in your life when you felt completely relaxed and happy (i.e. Favorite holiday)? ------------------------- ABOUT THE GOAL: What is it, exactly, you want to achieve with hypnosis? How will achieving this goal, change things for you? How will achieving this goal change things for those around you? (i.e. How will they respond to your changes?) What would happen if you never achieved this goal? What have you done to achieve this goal? What has stopped you achieving this by yourself? What evidence would you need to know you had achieved this goal? What would you see? What would you hear? What would you feel? What is motivating you to want this goal? What qualities of character would help the most in achieving the goal? Have you experienced Hypnosis before? If so, what was the goal, and the outcome? Any extra information that may be useful, please tell me now. ----------------------------------------------------------- Now please mail this form with your payment of £60 made out to 'Nathan Marika'. P&P free in UK, add £2.50 for international shipping. Need to convert your currency? Go to: www.currency-convertor.com. If for any reason that site is not up, simply search for any Free Currency Converter, there are many free sites providing such a service! Alternatively, why not 'wire' international fee's by using Western Union? Mail this form and any additional info to: Mrs. A. Silvey. Human Potential Technology. 64 Abbey Road. Wellingborough. NN8 2JP. UK This information is naturally treated as highly confidential, and will not be reproduced or made available to any other person or company.