Schedule An Appointment

If you’re ready to make some improvements to the way you think, feel, and behave, you can reach out to me by phone, email, or the contact form below, to arrange a free, no obligation conversation about whatever is troubling you.

Smoking Cessation treatments typically require only one session, and as such, smoking cessation treatments are excluded from this offer.

(Skype and FaceTime sessions are also available)

If you’d like for me to contact you by phone or by email, please fill out the form below, and specify in the Message box which form of contact you’d prefer.

The Smoker’s Questionnaire is a part of the form you’ll only need to fill out if you’re enquiring about stopping smoking. If you’re enquiring about any other type of issue, please do not fill out the Smoker’s Questionnaire.

(All information submitted via the form is 100% private and secure. See my Privacy / Data Protection Policy page for more details.)

First Name

Last Name

Email Address

Telephone Number (If preferred)

Message (Please tell me about any dates and times that suit you, regarding an appointment.)

Does your enquiry relate to becoming a non-smoker? Does your enquiry relate to becoming a non-smoker? Yes No

For how long have you been smoking?

When did you start smoking?

Why did you start smoking?

Who were you with when you started smoking?

Did someone you looked up to smoke? If yes, who?

Do other members of your immediate family smoke? If so, who?

Have you tried to stop smoking in the past? If so, when, how, and for how long?

What method did you use to stop smoking, and what happened each time that triggered you to start again?

How many cigarettes do you smoke a day?

How much money do you spend on cigarettes?

How could you better use the money saved by being a non-smoker?

Can you list three reasons why you want to become a non-smoker?

What fears might you have of quitting smoking?

Name some other people who would appreciate you becoming a non-smoker.

Do you believe that smoking is harmful to your health?

Do you ever experience shortness of breath?

Do you have a smoker's cough?

Do you have any other health problems related to smoking?

Do you have any other medical conditions?

Do you suffer from depression, epilepsy, panic attacks, psychotic episodes, dizzy spells?

When do you enjoy a cigarette the most? First thing in the morning, with coffee or other drink, as a reward, or other? (Please specify)

Do you smoke in your car or vehicle?

Do you smoke when you socialise or do you smoke to socialise?

Do you take a break just to smoke?

Do you use a vape?

Once you go to sleep at night, do you ever get up during the night to smoke?

Do you tend to smoke while you are talking on the telephone?

Do you smoke to feel confident?

Do you smoke more when you feel bored?

Do you smoke more when you are upset?

Do you smoke to replace overeating?

Do you sometimes think of your cigarettes as your friend?

Do you feel like a slave to tobacco?

How will your life be different as a non-smoker?

Are you ready to become a non-smoker?

On a scale of 1 to 10 with 10 being the highest, how much do you want to become a non-smoker?

If not a 10, what would you need to become a 10?

Do you have any worries or concerns about hypnotherapy?

Please list all cigarettes that you smoke throughout the day for each day, starting with your first and ending with your last.