Weight Loss - How I Can Help You - Shirley Webb Hypnotherapist | Cognitive Hypnotherapy and NLP, Hertfordshire Bedfordshire Cambridgeshire |


	Losing Weight
	I have helped many clients to lose weight. There is no magic formula for losing weight. Eating less and exercising more are the only ways to lose weight. Hypnotherapy can help you, not only to lose weight through the power of positive thought, but also to keep weight off by re-educating your unconscious mind. Do you find that losing weight can be easy, but keeping the weight off is hard? Or do you start diets full of good intentions but give up before you have achieved your target weight? Do you slip back into your old habits and put back even more weight than you lost? I can help you to lose weight and keep the weight off by working with your unconscious mind, helping you to break the habits that cause you to fail. To help me prepare for your session and personalise it to you, please complete as much of the confidential online questionnaire as you can.

Full Name *

Your Address *

Email Address *

Daytime Telephone Number *

Evening Telephone Number

Mobile Phone Number

Marital Status

Date of Birth

Gender

Children

Siblings

Occupation

Hobbies & Interests

Exercise

Name, Address & Phone Number of your GP

Do you suffer from any physical disabilities or injuries or have you had any recent operations?

Do you currently or have you ever suffered from epilepsy?

Do you currently or have you ever suffered from any mental disorders?

Are you currently under the Doctor?

What pills / treatment / alternative applications are you prescribed / taking?

What is your alcohol intake per week (units)?

Do you smoke?

Do you sleep well?

Did your Doctor recommend that you need to lose weight?

How old were you when you started having a problem with your weight?

Why did you think you can’t lose weight?

Is there anything you get out of being overweight?

Have you tried dieting before?

If so: How many times?

By what method(s)?

Why were they not successful?

How soon did you start gaining weight?

What caused you to gain weight again? (What was going on in your life?)

How did you feel whilst you were slimmer?

Are there any concerns you have about being slim?

Why do you want to lose weight?

What do you fear if you don’t lose weight?

What will happen if you lose weight?

What won’t happen if you lose weight?

What will happen if you don’t lose weight?

What won’t happen if you don’t lose weight?

How much do you weigh now?

How much do you want to weigh?

What was your slimmest adult weight and when?

Are there foods that you tend to focus most on?

How do you feel when you have finished eating?

Are there times when you stop yourself midway?

Have you ever purposefully made yourself sick after eating?

After you’ve finished eating, was there something you got from it that made it worth it?

To help analyse your eating pattern please identify when you are most likely to eat & where you eat

Times: I eat when I am feeling:

Hungry

Nervous

Bored

Hyperactive

Lonely

Stressed

Frustrated

Anxious

Happy

Sad

Insecure

Uncomfortable

Other:

For each item that you ticked above, please suggest an alternative activity to eating

Location: I eat too much or snack:

While reading

During coffee breaks

Between work and home

At my desk

With a drink / at the bar

At social events

in front of the TV

At business lunches

in bed

other:

For each item that you ticked above, please suggest an alternative activity to eating

Reasons - I treat myself to a snack or meal whenever I need:

Love

A reward

Companionship

Something to do

Comfort

A break from the routine

Relaxation

To feel secure

To feel important

Sexual attention

To compensate for something unpleasant

other:

For each item that you ticked above, please suggest an alternative activity to eating

Quest 4 Tranceformation

Losing Weight