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Transformational Hypnosis Therapy
CLIENT NOTES:
Your content has been submitted
CLIENT INFORMATION
PREFERRED NAME:
Ryan
DATE OF BIRTH:
February 3, 2025
PHONE NUMBER:
6319012195
ADDRESS:
140 Parlmont Park, North Billerica, MA 01862, USA
EMERGENCY CONTACT NAME & NUMBER:
Kerry Conlon
6313797812
RELATIONSHIP STATUS:
Mother
OCCUPATION:
Medical Assistant
How did you hear about us?
HEALTH INFORMATION
Are you being treated or have you ever been treated for any psychiatric illness? If yes, please explain briefly.
Yes I have been in therapy since about 9 years old and have been under the care of a psychiatrist since 13 years old. I have tried many treatments including most classes of antidepressants, TMS, ECT and ketamine injections. These have all been for major depression disorder and anxiety disorder
Have you ever seen a counselor, psychotherapist, or psychologist for any issue? If yes, please explain.
Yes, explained in previous answer.
Are you currently taking any prescribed medication? If yes, please list.
Duloxetine 30mg once daily
Duloxetine 20mg once daily
Clonazepam 0.5mg three times daily as needed
Bupropion 200mg once daily
Bupropion 150mg once daily
Propranolol 10mg three times daily as needed
Quetiapine 50mg once nightly
Quetiapine 25mg once daily as needed
Have you experienced any traumatic life events that I should be aware of? If yes, please explain.
My step father was very physically abusive toward my mother as I was a child. He would indecently expose himself to me as a child as well as have me drink and smoke cannabis with him as a teenager.
ADDICTIONS:
Smoking, Compulsive Behavior
ANXIETY
Stress, Fears, Phobias, Panic Attacks, Compulsive Behavior, Guilt, Trouble Relaxing, Lack of Confidence
EATING PROBLEMS
Food/Diet
DEPRESSION
Confidence, Self Esteem, Motivation, Acheiving Goals, Procrastination, Self Sabotage, Sleep Problems
CAREER ISSUES
Interview Skills, Public Speaking, Concentration, Memory, Driving Skills
CONCEPTION PROBLEMS
None or N/A
PAIN CONTROL
Mobility, Inflammation, Sight/Vision, Skin Problems, Chronic Pain
RELATIONSHIPS
Childhood Problems, Peer Problems, Romantic Problems, Coworker 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?
No.
What areas of your life would you like to work on?
Anxiety/panic response, especially extreme full body sweating and hot flashes
What is the biggest challenge that you wish to work on during your session?
Self control during times of anxiety/panic. Overcome sweating through my clothes and getting cold sweats afterward; then hopefully get more things done and have more self confidence.
Have you tried to do anything about this before now? If so, what?
A lot of therapy and medication. I used to meditate a lot but have not as of late. I try breathing technique and self soothing but it’s all to no avail.
EXPECTATIONS:
I’m not expecting to be cured but I do hope to 1, actually get hypnotized as I have never been before and 2, overcome at least some of my overreaction to uncomfortable situations and feelings that cause my body to react physically by sweating. I do understand Stephanie tries to focus on one specific topic but I am also hoping that I overall get a better sense of myself and how to relax and overcome some of the depression
Anything else I should know?
I don’t believe so
Are you willing to commit to listening to your personalized recording everyday for at least 21 days?
Yes I look forward to it
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?