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H.E.L.P. Hypnosis Exchange of Licensed Professionals

 A free referral service to locate licensed therapists and doctors who use clinical  hypnosis and hypnotherapy to augment psychotherapy and medical treatments

Licensed vs. Lay

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H.E.L.P. APPLICATION FORM
Items in red must be filled in.   
NAME:

DEGREE:

STATE:

SERVICE AREA:

OFFICE ADDRESS:

CITY, STATE, ZIP CODE:

OFFICE PHONE NUMBER:

E-MAIL ADDRESS:

LICENSE NUMBER:

DISCIPLINE:

NAME OF STATE BOARD:

BOARD PHONE NUMBER:

ISSUES TREATED WITH HYPNOSIS:

WEB SITE ADDRESS: http://

May we give your e-mail address to clients seeking treatment to speed the referral process? YES NO

Additional Comments:

helpform.html