Your Personal Health Survey

How serious you are about stopping?

Stop Smoking Cigarette ButtThis survey is aimed at assessing your history and current experience with being able to stop Permanently – so you can Stop For Good !!

Be sure to answer the questions honestly and the more information you can provide, the easier it will be for us to provide you with some feedback regarding your chances of stopping by Hypnosis. We will also keep you informed of any upcoming events which may be of benefit to you, unless you advise us otherwise. 

Take this opportunity to ask all the hard questions and any other inquiries about other bad habits, phobia's or challenges you may also facing.

AND... just to let you know, by simply filling out this survey in full for our research, you may win a free hypno club session! (we'll send you more details with your results)

Stop Smoking Survey
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Date / What Action did you take / What was the result
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There is an interesting correlation between parents and smoking. Choose if they did smoke and still do, or if they only smoked when you were born.
What have you always wanted to do (for YOU) and haven't made the time to do it or perhaps not often enough
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