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Client Intake Form

Please take a few minutes to answer the following questions as thoroughly and comprehensive as possible. The information you fill in here will assist me in delivering the very best session specifically tailored to your needs.
 RTT is a solution based theraphy.
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Email *
fenomenalforandring.no
certified RTT practitioner
"The presenting problem" : What is the main issue you would like to focus on and work on in the session(s) ? *
What is your deepest desire?What do you wish and want to achieve in the session(s)? *
Inger Garborg Amundsen is not a licensed physician, mental health professional or medical practitioner of any kind. She does not diagnose, prescribe or cure. Based on her hypnotherapy trainings & other mind- emotions techniques, she works with both the conscious and subconscious mind to assist people in making their own changes to their thinking, emotions, behaviours and reactions. inger garborg amundsen is an accredited and certified Rapid Transformational Therapy (RTT) practitioner. *
Required
I hereby release Inger Garborg Amundsen,Certified Hypnotherapist & RTT Practitioner, from any liability or claims that could be made against her concerning my mental and/or physical well-being during the work that has been outlined and agreed upon(now and in the future) by filling out this form. *
Required
I understand that Inger Garborg Amundsen  is not a licensed physician, psychologist, or medical practitioner of any kind and that hypnosis should NOT be considered a replacement for the advice and/or services, of a psychiatrist, psychologist, psychotherapist, or doctor. *
Required
I give Inger Garborg Amundsen full permission to hypnotise me and to use Rapid Transformational Therapy knowing that by participating fully in the process and by listening to my personalised recording for 21 days I play an important role in my overall success. *
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*Disclaimer: Hypnosis is NOT suitable for  people suffering from epilepsy, hallucinations, psychosis, schizophrenia or personality disorder. When dealing with a physical and/or mental illness or disease always consult a qualified physician or therapist. Please consult your doctor before making any health care decisions. *
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I understand that although Rapid Transformational Therapy & Hypnotherapy have an incredibly high success rate, Inger Garborg Amundsen cannot and does not guarantee results since my own personal success depends on many factors that Inger Garborg Amundsen has no control over, including my own willingness and desire to participate and affect the changes myself. *
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I understand, that I am responsible for my own health and safety at all times. I agree to participate in RTT hypnotherapy session done by Inger Garborg Amundsen of my own free will. *
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Full name *
e-mail: *
date of birth:
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adresse:
relationship status:
emergency contact name and nr:
From the lists below ,please check the areas  that are applicable to you. Please tick as many as you want.   Box 1. *
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box 2 *
box 3 *
box 4 *
box 5 *
box 6 *
box 7 *
box 8 *
What was your relationship like with your parents and siblings growing up?
HEALTH PROBLEMS (past & current).
What previous methods and/or treatments have you used,if used, in the past? Please feel free to briefly describe your experience(s).
Are you on any medication?
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Have you ever suffered from depression?
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Have you ever had suicidal thoughts
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COMMITTMENT! On a scale from 1 to 10 (10 being 100%), how committed are you to engage and participate in the session and the playing of the audio? This is the most important step for you to take, in order to benefit from the session. The mind learns from repetition,and it takes between 10 and 21 days to implement a new belief/habit. *
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