Adventure Hypnosis Request Form
Please Install Yahoo Instant Messenger BEFORE
filling out the form
I file requests by Yahoo nickname
If a form does not have an Yahoo ID nickname
it gets thrown into The Pile.
This form is not working, please email me if you want a session.
| Your E-mail Address:
| Your Name:
|What is your
| What is your
| What is your
| What is your
|What is your
What state/province are
(or country if outside of North America)
|What time zone
are you in? (I am in EST)
the adventure you want
Be as explicit as possible.
Storyline for Fantasy Adventures
A good story has a genre, so if you're wanting a fantasy adventure, please select all the genres that apply to your story:
Action (explosions, car chases, martial arts)
Adventure (heroes and villains)
Disaster / Survival
Horror (zombies, ghosts, evil spells)
Road movie (a quest or escape)
Sports (cheerleading, team sports, etc.)
Animated (cartoons, anime, furries)
Slapstick Comedy (cartoonish exageration)
Dark Comedy (Adams Family, Shaun of the Dead)
Drama (bad things happen to good people)
Melodrama (weepers, crying chick flicks)
Musical (only really works for phone sessions)
Are we leaning more towards:
Chick Flick (Emotions, Relationships, Drama)
Guy Flicks (Action, Sex, Violence)
A mix of both
Setting for the Story
Historical (pick a period of history)
Western (cowboys & outlaws)
Retro (within the last hundred years)
Rules of the universe
Are there sex change machines or spells?
Realistic (it could happen in real life)
Improbable (possible but unlikely)
Action Hero (the hero can't die)
Fantasy (magic, elves, witches, vampires)
Science Fiction (mad scientists, ray guns)
Unknown (everything seems normal, but is it?)
Surreal (art films, like dreams, don't necessarily make sense)
Premise of the story
The premise of a story is the initial situation that generates the plot. This is what you'd read in the TV Guide, the initial situation for a TV show. It doesn't reveal everything, which is the point, and gives opportunities for the viewer to be surprised by the story. I'm going to give a long list of examples, so you can pick one, or make your own.
Click here to open a new window with a list of examples
So, what's the premise of your story?
Describe your previous
your previous experience of trance or therapy if you have
any (or other experience relevant to your request)
What worked best,
and what didn't seem to work so well?
Please try the Hypno
Quiz and report the results (the link will open a new window)
try the HypnoQuiz NOW, I want to know the results)
Especially during the first
session, the end of the hour may come at a critical moment, and it
would be better to continue a bit longer for better results.
Knowing you would then pay
for additional time...
I don't want my session prolonged without being awakened and asked
I agree that my session can be prolonged by 15 minutes
I agree that my session can be prolonged by 30 minutes
I agree that my session can be prolonged by 60 minutes
I agree that my session can be prolonged by as much as my hypnotist sees
Online Chat software
is my Yahoo Instant Messenger ID (preferred)
is my MSN Messenger / Windows Messenger screen name
The operating software
on my computer is
(Vista WinXP, NT, WinME, Win98, Win95, Win3.1, MacOS, Linux,...)
What is your availability
for the next two weeks?
(if you are ready to have a session now)
How do you feel about
and allowing someone else be in charge for a short
time? Some amount of this is necessary for trance.
No problem, I can easily let someone else take over for a while
I can let someone else be in charge for a while if there's a good
I'd really rather be in control. I find it difficult to let go.
I need to always be in total control of what's going on. I
never let go.
Please describe your ideal hypnotist
kind of person are you looking for? Someone serious? Humorous? Detached?
Describe the limitations you want on your requests:
- Limits, things
you don't want
- Phobias or allergies you may have
|Are you living
with other people?
|Do you have
children or other dependants who might need your immediate attention
during a session ?
|Do you currently
have a sexual partner or spouse ?
Where did you hear
this website ?
(if you did a search on search engines, I would like to know what
you wrote in the search box to find me)
What can you afford
Regular in person sessions
(first session must be online or by phone to prove you are serious)
Occasional in person sessions
Regular phone sessions
Occasional phone sessions
Regular online sessions
Occasional online sessions
Just one session if I save up
I can't afford anything... pretty please?
What is your wish?
(the brief version of your request)
If you have not filled
out every section, I will ask you to fill out the
form again. Please do it right the first time.
It is better to write
more than not enough.
By clicking here, I freely
agree to have the adventure hypnosis done as requested by Linda and I understand
what that implies