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Transformational Hypnosis Therapy
CLIENT NOTES:
Your content has been submitted
CLIENT INFORMATION
PREFERRED NAME:
Julie
DATE OF BIRTH:
December 23, 1978
PHONE NUMBER:
3399272793
ADDRESS:
EMERGENCY CONTACT NAME & NUMBER:
Sheila Barter
508-740-6288
RELATIONSHIP STATUS:
Sister
OCCUPATION:
Business Owener
How did you hear about us?
Online google search
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. Regular therapy sessions about 15 years ago. Topics included relationships and wanting to change my behaviors.
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.
Nothing more than emotionally unavailable parents.
ADDICTIONS:
None or N/A
ANXIETY
None or N/A
EATING PROBLEMS
None or N/A
DEPRESSION
None or N/A
CAREER ISSUES
None or N/A
CONCEPTION PROBLEMS
None or N/A
PAIN CONTROL
None or N/A
RELATIONSHIPS
Romantic 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. My nephew has a genetic disease that causes seizures. But it's from the disease building up proteins on his brain. Not epilepsy.
Have you ever been hypnotized before?
Possibly. Theta brain state?
What areas of your life would you like to work on?
Working on clearing out so I can receive my soulmate, abundance of money.
What is the biggest challenge that you wish to work on during your session?
Soulmate reconnection
Have you tried to do anything about this before now? If so, what?
Yes. Self help. Core belief work. Energy healing, etc...
EXPECTATIONS:
Reconnect with my soulmate
Anything else I should know?
NO
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?