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Hypnotherapy Intake Form / HypnosisPS
Take your time to think about certain things and fill in this form as much information as possible. We will go over and discuss again at free consultation and 1st session. All information is private and confidential. HypnosisPS.com
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Email
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Your email
Name
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Your answer
Phone number - in case if email doesn't work
Your answer
Who referred you or how did you learn about Hypnosis PS and Tamami?
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Your answer
What is your situation of problem, issue or discomfort that you want to solve?
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Your answer
When did your issue or discomfort start?
Your answer
Do you have any major stresses in your life at present or earlier? If yes, briefly describe below:
Your answer
What emotions do you associate with your issue? i.e. anger, guilt, discomfort, tension, fear, incoherent, etc.
Your answer
Do you suffer any physical symptoms due to your issue? If yes, describe below:
Your answer
What are you doing currently regarding the situation? i.e physical therapy, medical treatment, medications, meditation, yoga, other therapies, nothing
Your answer
How will your life be like and how will you feel when you have changed and your issue is gone?
Your answer
What activities and events do you want to do if you don't have the issue or discomfort?
Your answer
Have you been hypnotized before?
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Yes
No
Tried but didn't work
Thank you for your answers. Do you want to have free 45 min Zoom consultation?
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Yes. Make an appoint from here:
https://calendly.com/hypnosisps/45-min-free-consultation
Rather communicate by chat / text / email
Still researching
Other:
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