Just $25 if I have worked

with you to get you off tobacco and we failed.

Become a non-smoker on February 14th if only or the ones you love.

First Session: Thurs February 9 at 6:30

QUIT Day/Second Session: Tuesday Feb 14 at 6:30

Follow-up Session: Saturday February 18th at 5PM

Declare your freedom tthis Valentine's Day. My unique 3 session program has helped thousands of Rhode Islanders quit smoking. And now I am making it available in a low cost group program in the privacy of your own home at a very affordable cost. Just $99 for the complete program (versus $495 individually in the office that hundreds have paid and gotten more than their money's worth - they have gotten free). No more excuses. Make this the year you get free.

*** Click here to join - you will receive an email with payment information $99***

* Please provide your name and address
* What is your email address?
Please list the year of your birth:
* Have we worked together before?
How did you first hear of me and my practice?
How much do you smoke currently (last week)?
Why do you want to smoke now?
Please let me know what YOU know about hypnotism. Check all that seem INCORRECT (NOT TRUE) to you. Add any comments or questions in the "other" box at the bottom of this question.
Please provide any background that you are comfortable sharing here. Include any other methods you may have tried to address the issue and why you have decided NOW is the time to make a change. Be as thorough or brief as you wish. Leave blank if the issue is sensitive and you prefer to talk further over the phone or in the office.
What is your most important reason to quit smoking?
Question Text


Please read carefully before you complete this intake form.


All conversations and transactions between hypnotist and client are confidential and will not be disclosed except by the client's written authorization.

The length, content and approach of each session are to be agreed upon prior to the hypnotic consultation. It is the client's right to know the estimated number of sessions recommended to achieve his or her goals. It is the client's right to file a complaint with the National Board of Hypnotists, Ethics Committee, Merrimack, NH as well as any state agency. It is the client's right to refuse any process by his or her own determination and to end hypnotherapy whenever he or she wishes with a pro-rated refund. It is the client's right to have the name of other practitioners in the community who may be available to work with him or her. Note: John Koenig is a Board Certified Hypnotist and is certified and trained to instruct new professional hypnotists (National Guild of Hypnotists).

John is a Board Certified Hypnotist and a Certified Hypnotist Instructor with the National Guild of Hypnotists.

He is not a medical doctor or licensed psychologist, psychotherapist, social worker, dietition or nutritionist and does not diagnose or treat any illness. He holds a Bachelor of Arts Degree in Psychology (Hofstra University, Hempstead, NY) and a Master of Arts Degree earned at the National University of Ireland (Dublin, Republic of Ireland).