Private Weight Loss Therapy Registration - Hypnosis by Doctors :Hypnosis by Doctors

Private Weight Loss Registration

You will be contacted for an appointment when we receive your completed form.

Please review the testimonials after submitting your form.

Date*
Month
Day
Year
First Name*
Last Name*
DOB*
Month
Day
Year
Age*
Marital Status*
Occupation*
Email*
Phone*
Please choose one of the following below:
- I would rather have a phone consultation
- I would rather have a zoom consultation
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

© Copyright 2024 All Rights Reserved