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At Mind Help Hypnotherapy Clinic we are committed to providing all of our clients with the highest standards of therapy. To ensure we fully meet your requirements, it would be much appreciated if you would complete this form.

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Therapy	- - - - - - - - - - - - - Suggestion Therapy Analytical Therapy

Please click the number (one to five) which corresponds with your level of satisfaction, where applicable: (5 = Excellent; 4 = Very Good; 3 = Satisfactory; 2 = Unsatisfactory; 1 = Very Unsatisfactory)

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Cost of therapy		1  2  3  4  5
Success of therapy		1  2  3  4  5
Would you recommend to a friend		1  2  3  4  5
Length of sessions		1  2  3  4  5
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