40-MINUTE FREE CONSULTATION

YOUR NEW LIFE IS ABOUT TO START!

Our free 40-minute consultation includes a chance to discuss your goals and challenges, learn more about hypnosis, answer all questions you may have, and ensure you’re a good fit for us.

Feel free to skip questions you’re not comfortable answering, but keep in mind that, the more you answer, the better we’ll be able to help you.

Once you complete the form, we’ll reach out within 24 hours to set up a Zoom meeting or a phone call – whichever you prefer.

All answers will be kept 100% confidential.

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Name *

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How Did You Hear About New Arcadia Hypnosis? *GoogleFacebookInstagramLinkedInReferralOther

If You Chose "Other", Tell Me Where Did You Hear About Us

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Which Program Are You Interested In? *Quit Smoking/VapingQuit PornographyQuit GamblingWeight LossStress ManagementFear Of FlyingKickstart Your BusinessTailor Your Program

What's Your Current Occupation?

Do You Enjoy Your Work? *

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• Prefer Not To Answer

Are You Satisfied With Your Income? *

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• No
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• Prefer Not To Answer

Are You Where You Want To Be In Life? *

• Yes
• No
• Prefer Not To Answer

Do You Feel Overwhelmed Often? *

• Yes
• No

Are You Currently Under Medical Care? *

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Are You Taking Prescribed Medication? *

• Yes
• No

Have You Been Diagnosed With A Mental Illness? *

• Yes
• No

Do You Exercise?

• Yes
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What Challenges Do You Need To Overcome Daily?

What Worries You The Most?

Tell Me About Your Hobbies

What Do You Expect From Hypnosis?

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