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Transformational Hypnosis Therapy
CLIENT NOTES:
Your content has been submitted
CLIENT INFORMATION
PREFERRED NAME:
Bonnie
DATE OF BIRTH:
December 9, 1960
PHONE NUMBER:
8022728870
ADDRESS:
EMERGENCY CONTACT NAME & NUMBER:
David Olson
802-487-5760
RELATIONSHIP STATUS:
spouse
OCCUPATION:
care giver and LNA
How did you hear about us?
saw on line
HEALTH INFORMATION
Are you being treated or have you ever been treated for any psychiatric illness? If yes, please explain briefly.
anxiety and family trauma
Have you ever seen a counselor, psychotherapist, or psychologist for any issue? If yes, please explain.
yes. I've seen counselors throughtout the years for anxiety, marrage problems, childhood trauma and miscellaneous things (my weight has been an obstacle for me).
Are you currently taking any prescribed medication? If yes, please list.
Duloxetine. And the following were prescribed after my heart stent was put in last August: Brilinta, Metoprolol, Jardiance, Lisinopril, Pantoprazole, Aspirin, Atorvastatin
Have you experienced any traumatic life events that I should be aware of? If yes, please explain.
I had an abortion at 17, sudden onset of anxiety attackes in my late teens, parents divorce, my mother left my father when I was 9yoa and we went into a battered womans shelter while living in TN, along with my 5 younger siblings, and l older sister.
ADDICTIONS:
Other
ANXIETY
Stress, Trouble Relaxing, Lack of Confidence, Other
EATING PROBLEMS
Food/Diet, Weight Problems, Exercise
DEPRESSION
Confidence, Motivation, Acheiving Goals, Procrastination, Self Sabotage
CAREER ISSUES
Concentration
CONCEPTION PROBLEMS
PAIN CONTROL
RELATIONSHIPS
Childhood Problems, Romantic Problems, Family Problems
DIABETES
None or N/A
Have you ever had serious thoughts of harming yourself or others?
yes
Do you or any member of your family have a history of epilepsy?
no
Have you ever been hypnotized before?
EMDR ?
What areas of your life would you like to work on?
improve my motivation, stop procrastination, eat better and excersize on a regular basis. I would like to lose maybe 30 lbs.
What is the biggest challenge that you wish to work on during your session?
Motivation and procrastination and put plan in place for weight loss and health.
Have you tried to do anything about this before now? If so, what?
many times, my biggest accomplishment was losing 25 lbs when I was 30yoa
EXPECTATIONS:
I look forward to getting the support I need to finally start living my best life. I had a heart attack at the end of August and did very well with my cardio physical therapy. I need motivation to keep active and eat better.
Anything else I should know?
I live in a rural area and have no access to health & fitness classes. I need to have motivation to regularly exercise at home.
Are you willing to commit to listening to your personalized recording everyday for at least 21 days?
yes
Are you 18 years of age or older?
Yes
AGREE TO TERMS:
I agree to all of the terms and conditions listed above.
WEIGHT CLIENTS
What is your ideal weight?
165-170
When was the last time you were at or near this weight?
30 years ago
What is the heaviest and lightest you have ever been?
size 10 late teens to now size 16-18
If you could design a relationship with food, what would it be like?
to eat a healthy breakfast, graze healthily during day and finish with small healthy dinner. Drink plenty of water inbetween.
Can you leave food or throw it away?
No. When eating out I usually make my meal 2 meals with the leftovers. Eating out is very expensive today, so is take-out.
Do you eat when you are bored, stressed or tired, or experiencing another emotion?
I believe so. I have intermittant thoughts of being a child and taking food from a neighbors trashcan and eating it.
Do you use food to comfort yourself?
Yes
Do you have good and bad days?
My days vary. Mostly good days I believe. I am grateful for what I have and have worked hard all my life.
Are your eating resolutions harder to stick to when you are out with friends?
Initially yes, but I adapt.
Were you given chocolate/cakes/trigger foods when you were growing up?
I don't believe so
Were any foods forbidden to you growing up?
no
Do you prefer to cook or eat out?
Eat out these days. But I like to cook certain foods.
24-Hour Recall
9:00am yesterday: coffee 2 cups, water, meds.
1:00pm sliced turkey with veggies on a ciabatta roll, water
5:30pm Went out for Valentines day dinner: 2 margharitas, app: clam strips w/ tartar. Dinner: fried haddock, baked potato, carrots Dessert: 1/2 of strawberry shortcake
Later that evening: No snacking, just water
8:00am today: 2 cups of coffee, water, meds
9:30am ciabatta roll with cream cheese and olives
Is this a typical day for you?
yes, pretty much. If I eat at home, I often have homemade soup and will have a bowl at some point during the day, for noon or evening meal. I also munch on mixed nuts, pretzels or chips, apples, oranges, what I have on hand.