Feedback - Healing Hypnosis

ALL INFORMATION ON THIS PAGE IS STRICTLY CONFIDENTIAL

This form is intended as a confidential method for you to provide feedback of your Hypnosis experience with Anthony M. Davis at Healing Hypnosis. There is no identifying information on this form. You are completely anonymous. This way you can feel free to openly share your perspective.

For instance, the following will be helpful to know whether or not something needs to be modified for future clients.

1. If something worked well for you I'd like to know.
2. If something seemed odd or made you feel uncomfortable in some way, I'd like to know.

Your feedback is VERY important as it is what I use to modify my sessions so that each person has the best experience possible.

How did you hear about Anthony M. Davis and Healing Hypnosis? *

Referral by Friend, co-worker, etc.

Referral by Doctor

Websearch (Google, Bing, Yahoo, etc)

Facebook

Twitter

Other website (Describe below)

Other

If someone asked about Healing Hypnosis, would You recommend Healing Hypnosis to friends, neighbors or co-workers?

YES

No

How would you rate your overall experience at Healing Hypnosis? *

Very Satisfied

Satisfied

Neutral

Unsatisfied

If you had a positive experience would you be interested in writing a small testimonial?

YES

No

For examples of other testimonials that clients have written visit: Testimonials

If you want to write a short testimonial, please write your comments below.

For your confidentiality, all testimonials are identified by either First Name, Last Initial (Sally, G) or as Anonymous. If you write a testimonial, How would you like it signed?

First Name, Last Initial (Sally G. / Robert M., etc)

Anonymous

If First Name, Last Initial, Please add that info here.

My Success Level *

My Issue or reason for seeking Hypnosis was resolved.

I have seen progress but feel that I need more sessions.

I have had no progress.

What POSITIVE things came from Your session (s)?

Please describe anything that you recommend doing differently.

Would You consider coming back for other sessions? *

YES

No

Do You have any other thoughts or comments you'd like to share that are not addressed here? If so, please share your thoughts below.

ALL INFORMATION ON THIS PAGE IS STRICTLY CONFIDENTIAL