Complete our online intake form. This questionnaire goes into great detail about your smoking habit from multiple angles. The information we gather will be used to create a custom-tailored hypnosis script that will only work on you and no one else. This high level of precision is one of many factors contributing to our 90% success rate.
Your honesty and accuracy are important for your success. The information collected is secure and will only be viewed by Mike Proulx, your hypnotherapist.
At your first live session with Mike, you will have the opportunity to clarify and elaborate on what you submitted. This is a casual conversation where you are encouraged to ask questions.
Below is the link to your Intake Form. IMPORTANT: Allow approx. 10-25 minutes to complete it. You must complete it in one sitting (you cannot save and continue later).
![]() |
How to prepare & listen to hypnosis audio.pdf Size : 168.984 Kb Type : pdf |