What is your age?
18-21
22-30
31-40
41-50
51-60
61-70
70+
Do you have any health issues?
Anxiety
Stress
Depression
Smoking
Chronic Pain
Sleep Problems
Skin Issues
Other
None
Hypnovia helps with healing at your unconscious level
Were you recommended by a nutritionist?
Yes
No
How long have you been struggling with nutrition problems, such as being overweight or binge eating?
0-6 months
6-12 months
1-3 years
4-5 years
5+ years
We know everyone’s overweight reasons are unique. What are yours? Select as many that apply.
Emotional eating
Binge eating
Chronic dieting
Lack of willpower
Poor digestion
Not sure
What physical symptoms do you normally experience? Select as many that apply.
Shortness of breath
Sweating more than usual
Snoring
Trouble sleeping
Skin problems
Fatigue
Back and joint pain
Not sure
How do these symptoms impact your life? Select as many that apply.
Physically uncomfortable
Nervous to socialize
Worried about travel
Struggle with work
Negative self-esteem
Not sure
How often does this happen?
Multiple times a day
Daily
Multiple times a week
Weekly
Monthly
Not sure
What financial costs have you had to deal with? Select as many that apply.
Many doctors visits
Expensive food/diet
Missing work
Ineffective supplements
Not sure
Many people fail to lose weight. Do you know why this happens?
Yes
Somewhat
No
Imagine yourself in 6 week time, how would you like to feel? Select as many as you want.
Physically comfortable
In control of my weight
Healthier in my body
Confident in myself
Not sure
What would you want to do if you were at your desired weight? Select as many as you want.
Enjoy social life/relationships
Sleep better
Travel with confidence
Play my favorite sport
Be more present at work
Not sure
How confident are you in achieving this with your current approach?
Confident
Somewhat confident
Not at all
How important is achieving this for you?
Very important
Important
Not important
How much time could you commit each day to managing your weight loss problems?
15 minutes
15-30 minutes
30-60 minutes
More than 1 hour
When is the best time in your day to listen to Hypnovia?
When I first wake up
In the morning
At lunchtime
In the afternoon/evening
Before I fall asleep
One last step...
Email
*