Confidential Stop Smoking Questionnaire
Please invest some time to complete this questionnaire. It will form the basis of your individual session with us.
Section 2: Medical History
This section concerns information that is important for our provision of high quality therapy and to fulfil our duty of care; and information disclosed herein is treated with strict confidentiality.
Section 3: Getting to Know You
This section is important because it helps us to tailor your hypnotherapy session to you, personally.
Do you understand the following?
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Something has to change
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The change has to be me
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The change has to be now
Section 4: Making it Official
I am now fully and totally, 100% committed to becoming a non-smoker and to remaining a non-smoker for the rest of my life; no matter what.