Online Smoking Cessation Registration | Hypnosis by Doctors :Hypnosis by Doctors

Stop Smoking Registration

Register & Pay $35 for Office Consultation

Date*
Month
Day
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First Name*
Last Name*
DOB*
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Day
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Age*
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Please choose one of the following below:
- I would rather have a phone consultation
- I would rather have a zoom consultation
Consultation Fee*
Price:
Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
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Supported Credit Cards: American Express, Discover, MasterCard, Visa
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Please Return to the Registration Page and See Testimonials Before Your Appointment.

WEIGHT LOSS

PAIN & MIGRAINE

STOP SMOKING

ANXIETY & DEPRESSION

ALCOHOL & DRUGS

GAMBLING

Dr. Clinton W. Smith, Psy.D

Clinical Psychologist & Hypnotherapist

For Assistance:

Call Us: (334)233-5610
Email Us: DrClintonwSmith@gmail.com
Office Address: 495 St. Luke Drive Montgomery, AL 36117

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