Permanent weight loss with hypnosis
www.hypno-slender.com
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Please sign me up for:

My FREE telephone consultation.
My FREE weight loss class. (We will email you a current schedule)
Both, My FREE consultation and My FREE weight loss class.

FREE CONSULTATION

Your free consultation call will last five to ten minutes. If you and I agree that our program is something that could work for you, we will refer you to one of our classes so you can get an in-depth evaluation and introductory hypnosis session for FREE.

FREE CLASS

Our FREE classes provide you with an in-depth evaluation of your weight loss needs and an introductory hypnosis session to get you started. The classes are fun, friendly, and easy. You’ll leave feeling refreshed, relaxed, and ready to lose weight.

YOUR PRIVACY

We always protect your information because having your trust and confidence is so important. We will not sell or even share your personal information without your express permission.

A FEW IMPORTANT QUESTIONS

Understanding your weight concerns and history with dieting will help us provide you with better support.


*1. How long have you carried extra weight?
     
*2. What diets or weight loss programs have you tried in the past?
   
*3. What success did you have with them?
 
*4. Which of the following do you need help with:













 


*5. How much weight would you like to lose?
 
*6. Name
 
*7. Address
 
*8. City, State & Zip
 
*9. Email address
*10. Phone Number (Please use the format: ###-###-####)
*11. What is the best time to contact you?
 
*12. Please tell us how you found out about our program.
 
* Please key in the access code you see displayed in the graphics box and then click submit.

In order to protect your privacy, Hypno-Slender.com has implemented a process that prevents unscrupulous spammers from running scripts that acquire email addresses from our site and submissions. The access code you see is provided in graphic format and can only be read by a human.

By taking a moment to key in the access code you are doing your part to eliminate theft and protect your information. If you have trouble reading the code, just click “submit” and you will be given a new code. Your information will remain on the form and you can try as many times as you need to.

If you are sight impaired and would like help please call (503) 371-3771.

Thank you,

Randy
Please Enter the code shown above in the box below


We will normally be able to contact you within 24 hours, except for weekends and holidays.

Thank you for allowing us to help.



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