Help Form

Please fill out the form as completely as possible.

Click here to save a PDF version of this form for your own use.

Please note that all fields followed by an asterisk must be filled in.

Explain your situation in detail:

What are the most prominent negative emotions you're feeling right now?

What/Where/Who will you be without these emotions?

Do you feel safe in giving up these negative emotions?

	Yes
	No

What is your biggest fear in regards to this issue?

How does this remind you of a past experience?

What would be the ideal outcome in this situation?

What is holding you back from achieving the ideal outcome in this situation?

May we post answers to your issue on our website where it may help others?

	Yes
	No

First Name*
First Name*

Last Name

E-mail Address*
E-mail Address*

Click here to save a PDF version of this form for your own use.

I recommend downloading the pdf version of this form, completing it for yourself and if you can't resolve your own issues by tapping on the answers to the questions, then you can email the pdf to me for help. I have used this form myself and cleared up days of deep depression and sorrow when my normal tapping wasn't helping. The questions on the form help you realize core issues that can knock down tons of trees in the forest all at once.

Please enter the word that you see below.

SBI!

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Help Form