Name * First Name Last Name Email * Is there a specific topic you would like to focus on for this intensive session? What is the primary reason you are seeking this hypnosis intensive? Please describe in detail what you hope to achieve & shift What specific outcome(s) or changes are you hoping to see after this session? For example, "Feel more confident," "Stop smoking," "Reduce anxiety," "Make more money," "Attract more clients" "Feel more at ease" etc Have you previously had hypnosis or other therapeutic modalities (e.g., EFT, EMDR, meditation)? Yes No If yes, please describe which modalities you have utilized and please describe the experience Do you have any particular fears, concerns, or misconceptions about hypnosis? Have you ever had experiences with hypnosis before? Yes, No, and if yes, please describe Are you open to exploring your subconscious mind during this session? * Do you have any spiritual or religious beliefs that should be considered during your session? * We ask this so that we can tailor that intensive specifically to align with you and your values. As a space holder, I utilize your own personal spiritual or religious beliefs to make the session even more impactful. On a scale of 1-10, how committed are you to achieving these goals? 1 = not committed, 10 = fully commited What will success look like for you after this hypnosis intensive session? Describe how you would feel or what would be different in your life after achieving your goal. Use this space to be as specific and clear as possible. Write this in the present tense as if all your goals and manifestations have been actualized. Are there any specific events, memories, or patterns from your past that you feel are contributing to the issue you're working on? What are your expectations for this hypnosis intensive session? Is there any specific guidance or support you are looking for from the hypnotherapist? What thoughts or inner dialogue come up when you think about manifesting your desire? Identify any resistance, doubts, negative self-talk, or limiting beliefs that you are consciously aware of. These can be transformed in your intensive How will you know you have been successfully reprogrammed? Describe any positive changes you expect to see in your personal, professional, or emotional life. What will be different and how will you feel different. Are you comfortable with relaxation techniques such as deep breathing, progressive relaxation, or visualization? Yes, No, or Somewhat Are there any past experiences or traumas that you feel need to be cleared before this manifestation can come to fruition? If you’re comfortable, please share any past experiences that may be blocking your manifestation. This could include past failures, disappointments, or limiting beliefs Is there any specific imagery, words, or symbols you would like included in your recording? * For example: an image of a lotus flower, a tree of life, a rainbow, a specific place that brings you joy, a path leading to a bright future, etc. Are there any specific visualizations, imagery, or techniques that would be potentially triggering for you or take you out of a space of safety? * We ask this in order to ensure that you feel as safe and comfortable as possible through the hypnosis portion. If there is anything that doesn't feel supportive, we want to make sure to be aware. On a scale of 1-10, how committed are you to manifesting this desire into reality? his will help assess your level of readiness and willingness to fully engage in the hypnosis process. How ready are you to make changes in your life related to this issue? Ready for immediate change Ready to begin the process Not quite ready yet, but open to it Do you follow any particular lifestyle habits that might affect your session? e.g., diet, exercise, sleep patterns, substance use, etc. Is there anything else you would like me to know or any questions you have? By signing below, you acknowledge that: You have provided accurate and truthful information to the best of your knowledge. You understand that hypnosis is a safe and effective therapeutic modality but that individual results may vary. You understand that hypnosis is not a replacement for medical or psychological care, and you will consult with a qualified healthcare provider if you have any concerns regarding your health. You give consent to proceed with the hypnosis intensive session. Thank you for taking the time to intentionally respond… your life will soon never be the same.Looking forward to this intensive with you!Happy Reprogramming!
