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What challenge or goal would you most like help with right now?

Stress or anxiety

Confidence or self-esteem

Sleep or relaxation

Breaking a habit (smoking, overeating, etc.)

Performance (work, sports, public speaking, etc.)

On a scale of 1–3, how ready are you to make a positive change in your life? (1 = just exploring, 3= ready to take action)

3, I'm ready to take action

2

1, Just exploring

How long have you been struggling with this issue?

Less than 3 months

3–6 months

6 months–1 year

Over a year

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The World is But a Canvas to the Imagination

www.imaginationhypnotherapy.com

Imagination Institute of Hypnotherapy

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