Personalized hypnotherapy form for Sexual problems.

Overcoming sex problems personalised mp3 order form

Please fill in the form below for a fully tailored and sex therapy personalised mp3 for overcoming sexual problems. I may contact you by email if I have any questions for you before I record your mp3, if you have any objection to this please indicate so in the last box.

sexual problem personalised mp3 form

Name

Email Address

Select your age

Select type of session you would like

Your Phone number (Optional)

select your gender

Select time that you have suffered from a sexual problem

Please tell me about your first memory of your sex problem

Is there any particular time when you feel that your sexual problemis at its worse? If yes please tell me about it.

Do you suffer from any allergies? If yes please give details.

Do you take any mind altering medication? If yes please give details

Please tell me in your own words and as much detail as possible about your sexual problem and how it makes you feel. Including anything you may think is relevant no matter how silly it may sound.Message