Dr. Clinton W. Smith, Psy.D
OFFICE OR PHONE COUNSELING
Weight Loss Registration Form
Stop Smoking Registration Form
General Registration Form
Get Started on the Process of Healing
- Save time and complete the appropriate registration form (above) before you come in for your one-hour consultation.
- Secure your private appointment with PayPal or any major credit card when you submit your registration form. Those who prefer to pay with a check will delay their appointment and should review the Fee for Services menu for details.
- Submit your form and/or print a copy and bring with you if you choose.
- Call to set your appointment at (334)440-6174.
Stop Smoking Registration
You will be contacted for an appointment when we receive your completed form.
Private Weight Loss
You will be contacted for an appointment when we receive your completed form.
Special Offer: Weight Loss Recordings (1) $19.95 (2) $35.00
Gambling Registration
You will be contacted for an appointment when we receive your completed form.
Alcohol & Drugs Registration
You will be contacted for an appointment when we receive your completed form.
General Registration
You will be contacted for an appointment when we receive your completed form.
Anxiety & Depression Registration
You will be contacted for an appointment when we receive your completed form.
Pain & Migraine Registration
You will be contacted for an appointment when we receive your completed form.
Free Weight Loss Registration Form
Free Stop Smoking Registration Form
Free General Registration Form
Trim-Style Weight Loss Recordings
These are Weight Loss Meditation Recordings for behavioral and emotional change that gets to the source of unhealthy habits. These recordings include psychological techniques to eliminate fattening foods, cravings, reduce portions, snacking, as well as to reduce stress and emotional eating. Consistent listening and applying the weight loss strategies will increase the desire for healthy foods, water and physical activity. They are extremely relaxing and produce an enduring state of calmness. Choose the recording(s) below that address your needs for creating weight loss habits. DO NOT LISTEN & DRIVE!
Pain Relief and Relaxation Recordings
There are (2) Pain Control Recordings that reinforce private and group pain management sessions. They produce deep relaxation, restorative sleep and include psychological pain relief techniques. They are not intended to treat medical conditions. Do not stop taking prescribed medication without your doctors advice. Do not listen and drive. Your recordings will be delivered via email. Receive (1) $19.95 or (2) $35.00.
Corona Anxiety Stress & Depression Release
There are more than (8) different recordings that are intended to reinforce private and group teletherapy sessions. They produce deep relaxation, restorative sleep, supports the immune system and include psychological techniques for positive change. Do not stop taking prescribed medication or listen when driving. Your recording will be delivered via email. Receive (1) $19.95 or (2) $35.00.
Short Therapy Session
Register & Pay $35 for Office Consultation
Register for a Free Weight Loss Session
This is strictly confidential! You will receive absolutely FREE a Behavioral Weight Loss Session in the comfort of your home.
Request An Appointment
Now You Have a Choice
Register For Consultation at Home
- Initial Consultation with Stress Control Recording & More Included $35 Click Here
- Initial Consultation at Home Free – Click Here
Dr. Clinton W. Smith, Psy.D
Clinical Behavior Therapist & Guided Meditation
For Assistance:
Call Us: (334)440-6174
Email Us: DrClintonWSmith@gmail.com
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