TELEPHONE SESSION REQUEST

CONTACT INFORMATION Name:
Telephone #:
E-Mail Address:

*Include your country code for numbers outside of the U.S.

TYPE OF SESSION Behavior Modifications:
Physical Transformations:
Humiliating Tasks:
Live Session Enhancement:
Fantasy Exploration:
Total Enslavement & Mind Control:

Category Descriptions

APPOINTMENT TIME Apointment Time: Session Length:

*Always use Eastern Standard Time(EST) and include am/pm.
*Provide the full date and time with requests given more than 12 hours in advance.

SESSSION GOALS What would you like to accomplish in your telephone session?

PHOBIAS OR FEARS Do you have any fears or phobias? yes :
no :
If Yes, list them here. It is best to avoid any subjects that deeply frighten you since intense fear is disruptive to hypnotic trance.

HYPNOSIS EXPERIENCE Have you ever been hypnotized? yes :
no :
If yes, list here any triggers or suggestions you remember. Also list anything that you find particularly potent in a hypnotic induction.

LIMITATIONS Do you have any personal or discretionary limits? yes :
no :
List here any limitations you want me to consider for hypnotic suggestions and training.

You will be sent an automated confirmation email shortly. If you do not receive this, check your junk mail and if the message is not there contact me to alert me to the problem.

TELEPHONE SESSION REQUEST

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