Health-care providers. Fill this form to refer a patient or client to Wise Hypnosis: Referer's (Doctor's) NameSelectDr. R. HrubyDr. JoanDr. EmmonsSelect your name from the drop list. If not found type it in the next text area (below)Type Referrer's Name (if not found above)Patient Being Referred to Wise Hypnosis *FirstLastPatient's E-mail Address *Please enter your email, so we can follow up with you.Which Areas Does Patient Need Help With? *PainSleepWeightDepressionHabitsOtherAdditional Notes to Wise Hypnosis *WebsiteSubmit