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Please tell me your preferences for your custom Richard Blumenthal hypnosis by completing this form. Thanks!

Your hypnosis will begin with a special place in your imagination.  Think of a place you would find relaxing and comfortable.  It could be a real place or a fantasy place.  It could be somewhere you've been before or somewhere you'd like to go.  

Please select the answers below that best describe your special place.  

Just click the down arrows to see your choices, or select "WRITE MY OWN" to enter your responses by typing any words or phrases in the space provided.

What is your special place?  Choose one from the select box or enter your own words or phrases.

the arctic a bay a beach a building a city a desert a farm a field a forest a garden a house a jungle a lake the moon a mountain an ocean outer space a path a planet a pond a river a road a room the sky a skyscraper a stream a street the tropics a tunnel a valley a village WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What do you see in your special place?  Choose three or enter your own words or phrases.

an airplane the arctic animals a bathtub a bay a beach a bed birds books a bridge a building a blue sky a candle a car a cat a chair a city clothing clouds a computer a couch a desert a desk a dog a door a dresser the earth a farm farm animals a field flowers the fog food a forest a garden a gate hills a horse a house insects a jungle jungle animals a lake a lamp leaves a mirror the moon a motorcycle a mountain an ocean outer space a painting a path people a photograph a planet plants a pond the rain a river a road rocks a room sand a sculpture the sea sea animals shelves a shooting star the sky a skyscraper a sofa snow a stream stars a street the sun the sunrise the sunset a table tools a train trees the tropics a truck a tunnel a valley a village a window WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.
an airplane the arctic animals a bathtub a bay a beach a bed birds books a bridge a building a blue sky a candle a car a cat a chair a city clothing clouds a computer a couch a desert a desk a dog a door a dresser the earth a farm farm animals a field flowers the fog food a forest a garden a gate hills a horse a house insects a jungle jungle animals a lake a lamp leaves a mirror the moon a motorcycle a mountain an ocean outer space a painting a path people a photograph a planet plants a pond the rain a river a road rocks a room sand a sculpture the sea sea animals shelves a shooting star the sky a skyscraper a sofa snow a stream stars a street the sun the sunrise the sunset a table tools a train trees the tropics a truck a tunnel a valley a village a window WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.
an airplane the arctic animals a bathtub a bay a beach a bed birds books a bridge a building a blue sky a candle a car a cat a chair a city clothing clouds a computer a couch a desert a desk a dog a door a dresser the earth a farm farm animals a field flowers the fog food a forest a garden a gate hills a horse a house insects a jungle jungle animals a lake a lamp leaves a mirror the moon a motorcycle a mountain an ocean outer space a painting a path people a photograph a planet plants a pond the rain a river a road rocks a room sand a sculpture the sea sea animals shelves a shooting star the sky a skyscraper a sofa snow a stream stars a street the sun the sunrise the sunset a table tools a train trees the tropics a truck a tunnel a valley a village a window WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What do you hear in your place?  Choose one or two or enter your own words or phrases.

animals birds a crowd food cooking forest sounds insects laughing machinery music quiet rain singing street sounds talking WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.
animals birds a crowd food cooking forest sounds insects laughing machinery music quiet rain singing street sounds talking WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What do you smell?  Choose one or two or enter your own words or phrases.

animals damp air food flowers fresh air night air nothing perfume paint people sea air something familiar something exotic stuffy air the forest WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.
animals damp air food flowers fresh air night air nothing perfume paint people sea air something familiar something exotic stuffy air the forest WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What time of day or night is it in your special place?  Choose one or enter your own words or phrase.

early morning morning early afternoon afternoon twilight evening night sunrise sunset timeless WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What is the lighting in your special place?  Choose one or enter your own words or phrase.

very bright bright light dim dusky dark WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What is the season?  Choose one or enter your own words or phrase.

Spring Summer Fall Winter WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What colors do you see?  Choose three or enter your own words or phrases.

Aqua Black Blue Brown Black Dark Green Green Grey Gold Lavender Light Brown Lime Green Light Green Maroon Navy Blue Orange Pink Purple Red White Yellow WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.
Aqua Black Blue Brown Black Dark Green Green Grey Gold Lavender Light Brown Lime Green Light Green Maroon Navy Blue Orange Pink Purple Red White Yellow WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.
Aqua Black Blue Brown Black Dark Green Green Grey Gold Lavender Light Brown Lime Green Light Green Maroon Navy Blue Orange Pink Purple Red White Yellow WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What are you doing in your special place?  Choose one or enter your own words or phrase.

bicycling driving floating flying jogging reclining resting riding running sitting skateboarding skating standing swimming walking wheelchairing WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What is the weather?  Choose one or enter your own words or phrase.

arctic breezy calm clear cloudy damp foggy raining snowing stormy sunny tropical windy WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



What is the temperature?  Choose one or enter your own words or phrase.

cold cool crisp hot warm WRITE MY OWN               If you select "WRITE MY OWN", a textbox will appear.



If you wish you may choose a prepared topic:

Quit Smoking Weight Loss Stress Management Pain Management Encourage Healing Enhancing Attractiveness Restful Sleep Dealing With Loss Anxiety Control Before Surgery After Surgery Increasing Self-Esteem Enjoying Life Resisting Substance Abuse Job Performance Improving Memory Test Performance Enhancing Assertiveness Sports Performance Anger Management Controlling Shopping Credit Card Wisdom Controlling Hyperactive Behavior Fitness Gambling Control Comfortable Flying Body Image, Body Shaping Time Management Posttraumatic Stress Controlling Obsessive/Compulsive Tendencies Pregnancy - Giving Birth Pregnancy - Morning Sickness Menopause Hot Flashes Great Golf Quit Marijuana Quit Drinking Alcohol Enjoying Intimacy Headache Relief Irritable Bowel Dental Visit SAT Exam Excellence Power Over Sugar Addiction Forget You Ever Smoked School Excellence Control Over Tinnitus



Create or add your own topic.
If you wish, you may enter any other ideas you'd like to give yourself during your hypnosis.  This could either be instead of, or in addition to choosing one of the prepared topics listed above.  Please use all appropriate punctuation.  Here are some examples:

I will face the challenges that lie ahead with courage and strength.
I am capable of achieving my goals.
When I feel overwhelmed, I will calmly focus on one task at a time.

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