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Click the check box next to each question
you can answer Yes to...
you can answer Yes to...
1. Have you ever been hypnotized?
2. Have you ever seen anyone hypnotized?
3. Do you believe hypnosis can help you with your problem?
4. Have you ever talked or walked in your sleep?
5. Have your ever awakened feeling that you couldn’t move or speak?
6. Are you basically a trusting person?
7. Do you have a lively imagination?
8. Do you ever daydream or fantasize?
9. Are you comfortable being touched by someone you trust?
10. Are you able to concentrate on an idea or thought?
11. Are you open to new ideas?
12. Do you follow directions easily?
13. Are you able to easily get in touch with your own emotions?
14. Do you believe a person can heal himself through his own mind?
15. Have your ever wished you could avoid taking medication?
16. Do you enjoy reading fiction and getting involved in the story?
17. Are you basically a religious or spiritual person?
18. Have you ever meditated?
19. Do you enjoy quiet times on occasion?
20. If you were to imagine sucking on a sour, bitter, juicy lemon,
would your mouth begin to water?
would your mouth begin to water?
| Count the number of questions you answered Yes to then |
| Art Leidecker, BCH |
| President of International Association of Medical and Therapeutic Specialists Founder of The Leidecker Institute - Elgin, Illinois Member Illinois Legislative Action Committee Member Board of Directors Hypnotist's Division of O.P.E.I.U./AFL-CIO |