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Transformational Hypnosis Therapy
CLIENT NOTES:
Your content has been submitted
CLIENT INFORMATION
PREFERRED NAME:
Yinny
DATE OF BIRTH:
June 13, 1988
PHONE NUMBER:
9788094873
ADDRESS:
156 Mt Vernon St, Lawrence, MA 01843, USA
EMERGENCY CONTACT NAME & NUMBER:
9788731537
Luisaelena Taveras
RELATIONSHIP STATUS:
sister
OCCUPATION:
tech
How did you hear about us?
online
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.
no
Are you currently taking any prescribed medication? If yes, please list.
high blood pressure
Have you experienced any traumatic life events that I should be aware of? If yes, please explain.
Yes, physical and verbal abusive parent.
ADDICTIONS:
None or N/A
ANXIETY
Stress, Fears, Panic Attacks, Compulsive Behavior, Guilt, Trouble Relaxing, Lack of Confidence
EATING PROBLEMS
Weight Problems, None or N/A
DEPRESSION
Confidence, Self Esteem, Motivation, Acheiving Goals, Procrastination, Self Sabotage, Sleep Problems
CAREER ISSUES
Public Speaking, Concentration, Exams, Memory
CONCEPTION PROBLEMS
None or N/A
PAIN CONTROL
Hair Growth
RELATIONSHIPS
Childhood Problems, 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
Have you ever been hypnotized before?
No
What areas of your life would you like to work on?
physical/mental/emotional/spiritual/setting and accomplishing goals and life purpose.
What is the biggest challenge that you wish to work on during your session?
Anxiety, mental and emotional
Have you tried to do anything about this before now? If so, what?
I try to work on myself often, but i never fully commit. When i get home from work i have so many distractions and also the believe that it'll not work for me.
EXPECTATIONS:
Hopefully i can find myself even if its a lil bit. i want to let go of attachment and self doubt.
Anything else I should know?
It can be hard for me to focus.
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?