Client Agreement

You will have each of your clients sign a stop smoking agreement. This is a contract, endorsed by both you and the client, which represents their commitment to live smoke free. This is a tool meant to psychologically bind your client to both the stop smoking process and to his own success.

Intake form

Once a prospect has indicated that he wishes to go forward with the stop smoking session, you'll email him something called a client intake form. The client must fill it up and send it back, or bring it with him the day of the session.

Below is a questionnaire, on which your client will write down information that is relevant to the smoking habit. This is a valuable tool for therapists, because it allows you to get an inside-glimpse of the relationship that your client has with smoking. Information gathered from the intake form also enables you to customize the stop smoking session before hand, to include your client’s personal motivations, obstacles and triggers.

                                                Intake Form

Name: ____________________________________________________________________

Date: ______________________________________________________________________

Address: ___________________________________________________________________

Home Phone: _______________________________________________________________

Mobile Phone: ______________________________________________________________

E-mail Address: _____________________________________________________________

Date of Birth: _______________________________________________________________

Occupation: ________________________________________________________________

How did you hear about us? ____________________________________________________

Phone number of primary care physician: _________________________________________

Please list any medication or treatment you are currently receiving from ANY health care

provider: ___________________________________________________________________

Did your doctor instruct you to stop smoking? _____________________________________

How many cigarettes do you smoke in an average day? ______________________________

Have you ever tried to stop smoking before? _______________________________________

Why do you believe you weren’t successful? ______________________________________

Why did you start again? ______________________________________________________

In what circumstances, places or events do you most feel the urge to smoke? _____________

___________________________________________________________________________

List your primary reasons to stop smoking: _______________________________________________

__________________________________________________________________________________

At what age did you begin smoking? _____________________________________________

How much money do you spend on cigarettes in a week? _____________________________

Experience Hypnosis - Confidence for Therapists Script

For those of you who have never been formally hypnotised or don't have much experience with hypnosis, we have included a short audio session that will give you an idea of what it's all about. This recording is designed to help you recall everything in this course, quickly, easily and at the appropriate moment. Before you listen, make sure that you are in a place that's safe and where you'll remain undisturbed for the next several minutes.

 Take a moment to make yourself nice and comfortable and just begin to breathe deeply. Deep, deep, breathing, now, because it feels absolutely wonderful to breathe deeply…and just allow that to continue, breathing deeply, that’s right, because it feels absolutely wonderful. 

And every time you breathe deeply, in and out, you’ll feel yourself relaxing a little more, as moment-by-moment, you find that relaxation beginning to deepen; becoming more profound and intense, as you enter hypnosis.

And just continue breathing deeply, and slowly, comfortably and calmly, soothing, relaxing, in every possible way. And it’s easy to listen to the sound of my voice, and relax even deeper, as all outside distractions begin to fade away.

You can easily imagine the things I suggest, it really takes no effort at all, to breathe deeply, and follow my words, so as every muscle begins to just relax and unwind.

And you can feel your arms and legs, going loose and limp, as your entire body becomes still and at ease, now, and every breath in makes you feel more calm and relaxed, every breath out, makes you feel less tense, and more at ease. All tension easing away as your thoughts begin to slow down.

And you feel more comfortable, more at peace; so calm and so comfortable that you just don’t feel like moving any more. As though any effort to move would be so difficult, that it’s so much easier to just relax and go even deeper, that’s right.

You could move if you wanted to, but you just don’t even feel like trying, because every breath relaxes you more, and takes you deeper into hypnosis. And it’s so easy to focus only on my words and nothing else as you effortlessly, go into trance.

You can feel your lungs opening up as you just let go, and relax even further, now, going deeper and deeper with every moment that passes by.

I’m going to count down from 5 to 0. And as I count, you’ll go 50 times deeper; 50 times deeper as I count down to zero, now.

5- going down, deeper and deeper, deeper and deeper,

4- all tensions easing away, as you relax, going deeper and deeper still,

3- relaxing more now, going deeper and deeper, and the deeper you go, the better you feel, and the better you feel, the deeper you go,

2-

1-

0- 50 times deeper. That’s right, 50 times deeper, feeling absolutely wonderful, as every muscle just melts to the floor, and you go deeper, deeper, and deeper still. 

And now you’re so deeply relaxed, so deeply at ease, that you subconscious mind is open fully to my suggestions. 

And from this point forward, everything you’re learning, here, just becomes a natural part of who you are. You’re going to feel good about using it, you’re going to feel confident about using these techniques, and this information is just going to get easier and easier for you to recall.

And you know that you’re learning everything you need, here, now, to use this with total confidence with anyone you choose, wherever you choose, and you feel absolutely great about your ability and your potential.

And as you go through this course, you’re going to soak everything up at the subconscious level, and you’re going to remember all this information perfectly, and be able to recall the right thing at the right time, without even having to make an effort.   

Starting right now, you know that anytime you choose to use anything you learn here, it’s just going to come right back into your mind, whatever information you need is going to be right there, exactly when you need it.

And it’s going to get easier and easier to use these skills throughout the course. Every day you’re going to absorb even more, and you’ll find your confidence growing and growing, and everything you learn just stays with you. It’s just a natural part of who you are, and it feels great. 

Now, I’m going to count from 1 to 5, when I reach the count of five, you’ll be fully alert, completely relaxed, feeling absolutely fantastic, knowing that whatever you learn stays locked into your inner mind, waiting to come forward whenever you need it. Now,

1-coming back,

2-more alert,

3-energy flowing into your body, rejuvenating, empowering the body and mind,

4-big stretch and

5-all the way back, fully alert, feeling fantastic.