Please take a moment to answer a few questions. Your response to these will help me tailor a hypnosis program to meet your needs and expectations. (Click the "Finish" button at the bottom of the form to complete).

Please enter the information indicated below, including your preferred mailing address.

Please provide the phone number you would like me to call for our phone sessions.

I can make a recording of your session which I will send you 2nd day USPS at no extra charge to the mailing address you provided above. I do not have the ability to make an MP3. Do you prefer:

Your first choice for day/date, time and time zone for our first session. Allow approximately 60 minutes when you will be undisturbed. The broader time range you suggest, the easier it will be for me to accommodate you.

Example: Tuesday, July 5, 5-7 PM (Pacific Time Zone).

Your second choice for day/date, time and time zone for our first session. Allow approximately 60 minutes when you will be undisturbed. The broader time range you suggest, the easier it will be for me to accommodate you.

Example: Thursday, July 7, 3-4 PM (Pacific Time Zone).

What is your date of birth (month, day and year)?

Your gender?

Have you been hypnotized before?

Do you have any excessive fears or phobias?

Experience with psychotherapy.

What are your attitudes and expectations about hypnosis? We will talk about hypnosis and what to expect at your session and I will answer any questions. But your answers to these questions will give me an idea of your current understanding and expectations.

Everyone can be hypnotized. However, people respond to hypnosis in different ways. This little survey will help me understand how to best help you achieve a productive hypnotic state. Thank you for your patience.

What is the main issue you wish to handle with hypnosis? While we can often add a secondary objective, it is best to have a clear focus for your session.

What barriers or challenges do you face when dealing with this issue?

What have you done so far to deal with this issue? Please list professionals you have seen, programs you have tried, describe your personal efforts, etc.

What other issues would you like to address if possible?

Where did you first hear of me (please list friend, doctor or therapist's name at bottom if you were referred)?

PLEASE READ BEFORE YOUR PHONE HYPNOSIS SESSION

You can experience your hypnosis by phone session through (in order of preference):

-Regular telephone
-A speaker phone
-Phone headset so that your hands are free

Avoid taking "recreational" drugs or alcohol before your session, as they can prevent you from becoming hypnotized or benefiting from the session. 

Make sure that you can relax and will be undisturbed for approximately  60 minutes. 

Disable call waiting or any electronic device that you think might disturb you. 

Also, be sure that other people won't enter the room during your hypnosis by phone session.  It is best to feel without any time pressure, so make sure you have no further appointments. 

Ask family or others sharing your home to be quiet and to avoid entering the room during your session.  It is important that you not be interrupted under any circumstances other than genuine and serious emergencies. You might even want to place a do not disturb sign on your door during the session.

Choose a place where you can be comfortable when you are being hypnotized.  Many people enjoy using a recliner during phone hypnosis however any other sort of comfortable furniture can work. You can even lie on the floor if that suits you.   Pets need to be in another room or space during your hypnosis by phone session.  This includes even your beloved cats or dogs.  Your temperature drops when you are in hypnosis so you may want to have a warm blanket. Make sure to take a bathroom break before your session begins.

Hypnosis and full bladders do not mix well.In the event that the connection should be lost, I will attempt to reconnect and continue immediately.  If we are not able to, we will reschedule your appointment via email. Naturally, we understand that circumstances might arise which would require you to change your appointment. 

In this case, please email me at jkhypnosis@aol.com as soon as you know and I will be happy to arrange another time for your session. Your CD or audiocassette of your phone hypnosis session will be mailed to you. Please make your payment 24 hours before your scheduled session or as soon as you send in the hypnosis by phone input form.            

PLEASE READ CAREFULLY BEFORE YOU HIT THE SUBMIT BUTTON.

All conversations and transactions between hypnotist and client are confidential and will not be disclosed except by the client's written authorization.

The length, content and approach of each session are to be agreed upon prior to the hypnotic consultation.

It is the client's right to know the estimated number of sessions recommended to achieve his or her goals.

It is the client's right to file a complaint with the National Guild of Hypnotists, Ethics Committee, Merrimack, NH as well as any state agency.  

Note: John Koenig is a Board Certified Hypnotist (National Guild of Hypnotists). He holds a Bachelor of Psychology Degree from Hofstra University in Hempstead, New York and a Master of Arts Degree from the National University of Ireland in Dublin, Ireland. 

He is not a medical doctor or licensed psychologist, psychotherapist or social worker and does not diagnose or treat any illness.

The fee for your telephone hypnosis session is $80. Plus $4.50 for shipment of your free recording. These are very useful for reinforcement. Please indicate your preferred method of payment.