What is your name?

First Name

Last Name

What town or city will you be coming from?

I'm curious, how did you come to find me?

If by referral, who may I have the pleasure of thanking?

What is your phone number?

(###)

###

####

What are the best times for me to give you an initial phone call?

Monday 9-11 am

Tuesday 9-11 am

Wednesday 9-11 am

Thursday 9-11 am

Please describe how you qualify for this offer.

How would you like flexibility in your payment?

3 monthly installments

$300 + trade

What experience would you like to explore?

QHHT Hypnosis "Lite" (5 hrs)

Psilocybin-Assisted Quantum Hypnosis (5 hrs)

Which available session date would you like to reserve?

You can choose from the page "Available Dates".

YYYY

What are 3 of your highest intentions for your session?

What else would you like to share with me? Any questions you'd like me to answer during our initial call?

Thank you!

I’ll be replying by text very soon to arrange a phone introduction and scheduling.

if you are in explicit financial need

you can choose 1 of these 2 offers.