Suggestibility Questionnaire 1

The following is a conditioned response test designed to help your Hypnotherapist assist you more
rapidly with your program. It is important that you answer these questions truthfully, keeping in mind
there are no right or wrong answers. Go with the first answer that comes to mind after you read
the question. Try not to dwell on any question. Simply check es or !o "eside each question.
QUESTION YES NO
1 Have you ever
walked in your sleep
during your adult life?
NO
2 As a teenager, did
you feel cofortable
e!pressing your
feelings to one or
bot" of your #aternal
and $aternal figures?
%&S
' (o you "ave a
tendency to look
directly into people)s
eyes and*or ove
close to t"e w"en
discussing an
interesting sub+ect?
NO
, (o you feel t"at ost
people you eet for
t"e first tie are
uncritical of your
appearance?
NO
- .n a group situation
wit" people you "ave
+ust et, would you
feel cofortable
drawing attention to
yourself by initiating a
conversation?
%es
/ (o you feel
cofortable "olding
"ands or "ugging
soeone you are in a
relations"ip wit" w"ile
ot"er people are
present?
%es
0 1"en soeone talks
about feeling war
p"ysically, do you
begin to feel war
also?
NO
2 (o you occasionally
"ave a tendency to
tune out w"en
soeone is talking to
No
you, and at ties not
even "ear w"at t"e
ot"er person is
saying, because you
are an!ious to coe
up wit" your side of
it?
3 (o you feel t"at you
learn and
copre"end better by
seeing and*or reading
t"an by "earing?
Soeties
14 .n a new class or
lecture situation, do
you usually feel
cofortable asking
5uestions in front of
t"e group?
NO
11 1"en e!pressing
your ideas, do you
find it iportant to
relate all t"e details
leading up to t"e
sub+ect so t"e ot"er
person can
understand it
copletely?
%es
12 (o you en+oy relating
to c"ildren?
(epends
1' (o you find it easy to
be at ease and
cofortable wit" your
body oveents,
even w"en faced wit"
unfailiar people and
circustances?
NO
1, (o you prefer reading
fiction rat"er t"an
non6fiction?
%es
1- .f you were to iagine
sucking on a sour,
+uicy, yellow leon,
would your out"
water?
No
1/ .f you feel t"at you
deserve to be
copleented for
soet"ing well done,
do you feel
cofortable if t"e
coplient is given
to you in front of ot"er
Soeties
people?
10 (o you feel t"at you
are a good
conversationalist?
No
12 (o you feel
cofortable w"en
coplientary
attention is drawn to
your p"ysical body or
appearance?
No
TOTAL

Suggestibility Questionnaire 2
The following is a conditioned response test designed to help your Hypnotherapist assist you more
rapidly with your program. It is important that you answer these questions truthfully, keeping in mind
there are no right or wrong answers. Go with the first answer that comes to mind after you read
the question. Try not to dwell on any question. Simply check es or !o "eside each question.
QUESTION YES NO
1 Have you ever
awakened in t"e
iddle of t"e nig"t and
felt you could not
ove your body and*or
could not talk?
No
2 As a c"ild, did you feel
t"at you were ore
affected by t"e tone of
voice of your #aternal
and $aternal figures
t"an by w"at t"ey
actually said?
%es
' .f soeone you are
associated wit" talks
about a fear t"at you
too "ave e!perienced,
do you "ave a
tendency to "ave an
appre"ensive or fearful
feeling also?
No
, .f you are involved in
an arguent wit"
soeone, after t"e
arguent is over do
you "ave a tendency
to dwell on w"at you
could or s"ould "ave
said?
yes
- (o you "ave a
tendency to tune out
occasionally w"en
%es
soeone is talking to
you, per"aps not even
"ear w"at was said,
because your ind
"as drifted to
soet"ing totally
unrelated?
/ (o you soeties
desire to be
copleented for a
+ob well done, but feel
ebarrassed or
uncofortable w"en
copleented?
yes
0 (o you often "ave a
fear or dread of not
being able to carry on
a conversation wit"
soeone you "ave
+ust et?
yes
2 (o you feel self6
conscious w"en
attention is drawn to
your p"ysical body or
appearance?
yes
3 .f you "ave your
c"oice, would you
rat"er avoid being
around c"ildren ost
of t"e tie?
no
14 (o you feel t"at you
are not rela!ed or
loose in body
oveents, especially
w"en faced wit"
unfailiar people or
circustances?
yes
11 (o you prefer reading
non6fiction rat"er t"an
fiction?
fiction
12 .f soeone describes
a very bitter taste, do
you "ave difficulty
e!periencing t"e
p"ysical feeling of it?
no
1' (o you generally feel
t"at you see yourself
less favourably t"an
ot"ers see you?
yes
1, (o you tend to feel
awkward or self6
conscious initiating
touc" 7"olding "ands,
kissing, etc8889 wit"
soeone you are in a
no
relations"ip wit" w"ile
ot"er people are
present?
1- .n a new class or
lecture situation, do
you usually feel
uncofortable asking
5uestions in front of
t"e group even t"oug"
you ay desire furt"er
e!planation?
yes
1/ (o you feel uneasy if
soeone you "ave
+ust et looks you
directly in t"e eyes
w"en talking to you,
especially if t"e
conversation is about
you?
no
10 .n a group situation
wit" people you "ave
+ust et, would you
feel uncofortable
drawing attention to
yourself by initiating a
conversation?
yes
12 .f you are in a
relations"ip or are very
close to soeone, do
you find it difficult or
ebarrassing to
verbali:e your love for
"i or "er?
yes
TOTAL
www8Nu6;lear8co < =ased on t"e work of (r8 >o"n ?appas