Check your eligibility and start today

1. Enter your details below then check if you’re eligible.
2. If you are eligible you will be taken to the signup page.
3. Successful applicants can begin the program immediately.

• First Name*
• Last Name*
• Email*
• Phone*
• Postcode*
• How many do you smoke per day?*Select123456789101112131415161718192021222324252627282930
• What methods have you used in the past to quit?
  • Hypnosis
  • Champix
  • Zyban
  • Nicotine patches
  • Nicotine inhaler
  • Nicotine nasal spray
  • Nicotine lozenges
  • Nicotine gum
  • Nicotine microtab
  • Vaping
  • Cold turkey
  • Other
  • None of the above
• Do you suffer from any of the following conditions?*
  • Epilepsy
  • Fitting
  • Schizophrenia
  • Psychosis
  • Depression
  • Anxiety
  • Insomnia
  • Heart Conditions
  • None of the above
• How would you describe your weight?Select OneIdeal WeightUnderweightOverweight
• What is the main reason you have decided to quit smoking now?
• Future Sessions*
  • Yes
  • No
  Would you be interested in receiving information about other hypnotic sessions as they become available?