Affiliate Program

Application to Become an AHA Affiliate

Congratulations on your decision to apply to become an Advanced Hypnosis of America Affiliate. As an affiliate you will benefit from our marketing and the opportunity to grow your practice through our nationwide advertising and promotion. If you are selected we will provide you with clients you might not have otherwise been introduced
to. This will enable you to concentrate on Hypnosis and leave the marketing to us.
If you have more that one location please submit an application for each one. We look forward to working together with you to advance the art and science of Hypnotherapy.

Note: If you experience any technical problems submitting this form online, please let us know and feel free to print it out and fax it to us at (888) 866-8152.

Add Affiliates

Please provide the following (*) Required
First Name:*
Last Name:*
Title:
Name of Practice:
Physical
Address:*
City:*
State:*
Zip:*
Mailing (Use same as physical address)
Address:*
City:*
State:*
Zip:*
Phone Number:*
Alt. Phone:
Fax Number:
Email Address:*
Web Site:
Tax ID Number:*
Membership Status:
Sales Stage:
Contact Next:
Scheduling Method:
Reserved Appointment Times:
Office Hours:
Online Calendar:
Username:
Password:
Notes:
Therapist Certifications
1. Certifications*
(Hold down the ctrl key while you click to choose more than one)
Other:
2. Issues for which you are a qualified and capable care provider.*
(Hold down the ctrl key while you click to choose more than one)
Other:
Education
3. Please check any degrees/licenses that you have earned.
(Hold down the ctrl key while you click to choose more than one)
Details:
Experience
4. How Many years have you been practicing hypnotherapy?*
5. Please describe you work history in the field.*
Philosophy, Style & Affiliations
6. Please check off the styles and techniques of hypnotherapy you are comfortable using.
(Hold down the ctrl key while you click to choose more than one)
Other:
7. Please list organizations you are a member of.
(Hold down the ctrl key while you click to choose more than one)
Other:
8. Please describe your philosophy and style regarding the practice of hypnotherapy.
Working Together
9. Please write a one or two paragraph summary of your qualifications we can pass along to prospective clients and for marketing purposes. Please write it in the second person perspective (ie, “Dr. Williams has achieved…. she accomplished… he did…” not “I earned this… or I achieved this…”).
10. Do you have a receptionist? (Executive suite/shared receptionists are fine)
yes
no
11. In what kind of facility is your clinic located?
12. Please give us directions to your clinic from the major highways coming from different directions.
13. Please list up to three cities (other than the city listed in your address)that are nearby and that clients are usually willing to travel from in order to seek hypnotherapy with you. For example, a business address could be in Encino, CA which is a suburb of Los Angeles. In that case you would include Los Angeles as well as Santa Monica and perhaps Beverly Hills.

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Clients Testimonials


"Just wanted to let you know I had an excellent meeting with Daniel on May 6th. He spent almost three hours with me...and I haven't smoked since. It was a very interesting evening.  It's going very well and seems to be "easier" than I anticipated to stay away from the cigarettes."

-Phil

“I feel wonderful. Not one craving for a cigarette. I even went to a friend’s house last night and had a couple beers and was around 4 people that were smoking and still no craving. This is truly amazing. Everyone is so impressed with me and figure if I can quit so can they.”

- Vera M.

“I went to see Matt and he helped me tremendously. I am so glad I haven't pulled my eyelashes at all since my first visit. It took 4 or 5 sessions and when I went last week he said that I was done. I was shocked that it was that easy. I just wanted to thank you for sending me to him. I highly recommend him to future patients and if you ever need to use me as a reference for him I would be happy to do so. Thanks again for all your help.”

- Jessica

"I want to thank you so very much for sending me to Marianne. The only experience I had ever had with hypnosis was at county fairs and I was afraid this would be similar.  She took me to exactly where I thought I wanted to go and I am so much more at peace now.  I know now without a doubt that what I want to happen will happen in its due time.  Again I want to thank you so very much. You will be hearing from me again."

- Susan

Scientific Evidence

Hypnosis has been proven scientifically to be highly effective in treating:
  1. Smoking (Texas A&M and others)
  2. Weight Loss (Oxford University and others)
  3. Pain Management (Stanford University and others)
  4. Drug & Alcohol Addiction (Ohio State University and others)
  5. Healing Faster (Harvard University)
Learn more...