Quantum Journeys Hypnosis | Bessie Estonactoc

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home.
work with me.
Quantum Hypnotherapy
A private, in-depth session that guides you beneath everyday awareness into the subconscious mind. 1:1 sessions and monthly package.
The A.R.T. of Spiritual Living (coming soon)
My signature three-month private mentoring experience for the woman ready to create meaningful change.
The Portal

(My Signature Program)
An eight-week guided journey through the chakra system blending spiritual growth, community connection, reflective practices, and hypnosis.
the portal.

Quantum Journeys Hypnosis Intake Form

Please fill out the following form

First name*

Nickname (if you have one)

Email*

Date of birth

Month

Day

Year

Marital Status

Occupation

Overall Health

Have you been hospitalized in the last 12 months?*

No

Yes

Are you suffering from a medical condition, illness or injury?*

No

Yes

If you answered yes to any of the questions above, please supply additional information.

Multi choice*

Addictions

Anxiety Stress

Phobias

Panic Attacks

Grief

Loss of a loved one

Disordered Eating

Weight Problems

Career Issues

Concentration

Confidence

Procrastination

Achieving Goals

Sexual Problems

Pain Control

Relationships

Childhood Problems

Sleep Problems

No Problems; I Want to UPGRADE My Life

Any additional notes?

Initials*

I declare that the info I’ve provided is accurate and complete.

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If you have questions you can email me at bessie@bewithbessie.com

© 2026 – All rights reserved • Bessie Estonactoc

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