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Transformational Hypnosis Therapy
CLIENT NOTES:
Your content has been submitted
CLIENT INFORMATION
PREFERRED NAME:
"Jordan"
DATE OF BIRTH:
April 1, 1982
PHONE NUMBER:
4433267032
ADDRESS:
270 17th St NW, Atlanta, GA 30363, USA
EMERGENCY CONTACT NAME & NUMBER:
Geoff Streat
4042428262
RELATIONSHIP STATUS:
Single
OCCUPATION:
Writer
How did you hear about us?
IG
HEALTH INFORMATION
Are you being treated or have you ever been treated for any psychiatric illness? If yes, please explain briefly.
no
Have you ever seen a counselor, psychotherapist, or psychologist for any issue? If yes, please explain.
Yes. A counselor. Initially it was for couple's therapy, now its' just for me.
Are you currently taking any prescribed medication? If yes, please list.
no
Have you experienced any traumatic life events that I should be aware of? If yes, please explain.
The death of my father, godfather, aunts and other family members has been tough. Also, the recent breakup has been blindsiding.
ADDICTIONS:
Other
ANXIETY
Stress, Fears, Guilt, Trouble Relaxing, Lack of Confidence
EATING PROBLEMS
None or N/A
DEPRESSION
Confidence, Self Esteem, Motivation, Acheiving Goals, Procrastination, Self Sabotage, Sleep Problems
CAREER ISSUES
Concentration, Memory
CONCEPTION PROBLEMS
PAIN CONTROL
Inflammation, Sight/Vision
RELATIONSHIPS
Childhood Problems, Romantic Problems, Coworker Problems, Family Problems
DIABETES
None or N/A
Have you ever had serious thoughts of harming yourself or others?
no
Do you or any member of your family have a history of epilepsy?
no
Have you ever been hypnotized before?
once, over 20 years ago
What areas of your life would you like to work on?
I was in a relationship that as I look back, was emotionally abuse. I let myself be manipulated, leaning to her needs while not having mine met. I was unhappy with the relationship for the last 9 months of it. However, when I make a commitment, I see it through and I convinced myself that our issues could be worked out. Now, I believe that my ex had no real intention of building a healthy relationship. Instead, she thrived off of my unhappiness, our conflict and my validation. Now that I'm out, I realize how unhealthy this situation was. Unfortunately, I'm still experiencing the grief of what I though was becoming a lifetime bond with a person that I now know that I never truly knew. It's hard not to think about it. It's hard not to feel like something's missing. As a matter of fact it feels like how people describe withdrawal symptoms. I'm finding it hard to focus, get to sleep, stay asleep, my appetite has been affected. It's like my brain and body are out of alignment.
What is the biggest challenge that you wish to work on during your session?
I'm a great guy. I want to own that. I want to level up with my confidence. I'd like to be able to get to sleep earlier, wake up earlier, be more organized and manage my time and energy much better.
Have you tried to do anything about this before now? If so, what?
Yes, meditation helps, working out helps, intermittent fasting helps keep my mind elsewhere.
EXPECTATIONS:
I want to conclude our sessions with a newfound level of confidence that can be seen on me, heard in my voice, reflected in work and my relationships.
Anything else I should know?
Over the past 7 years, there's been a lot of grief in my life. That includes my dad. I'd like to process that.
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?
When was the last time you were at or near this weight?
What is the heaviest and lightest you have ever been?
If you could design a relationship with food, what would it be like?
Can you leave food or throw it away?
Do you eat when you are bored, stressed or tired, or experiencing another emotion?
Do you use food to comfort yourself?
Do you have good and bad days?
Are your eating resolutions harder to stick to when you are out with friends?
Were you given chocolate/cakes/trigger foods when you were growing up?
Were any foods forbidden to you growing up?
Do you prefer to cook or eat out?
24-Hour Recall
Is this a typical day for you?