• New Client Discovery Intake Form

    Transformational Coaching & Hypnosis
  • Self Discovery Questionnaire

    This questionnaire is designed to identify important themes, treatment goals, and preferred strategies to support us in developing the most effective therapeutic/coaching relationship. Please fill out all areas to the best of your ability (and comfort level) before our first session together. Don't worry too much about it - we can always discuss anything that feels relevant during our sessions and the treatment trajectory and goals are always your choice and are modifiable at any point in time. We may ask you to complete this form again after a few sessions to see where you are then.
  • First things first. Tell me some of your demographic background and how you'd like me to refer to you!

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    Pick a Date
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  • Current Life Experience

    This section is intended to provide you with a snapshot of your current life experience. We will refer to this assessment as we progress through our sessions to track changes and orient therapeutic interventions and goal-setting in a way that truly supports your needs. There will be several different sections that you'll progress through. Please take your time and answer honestly.
  • Well Being and Satisfaction Assessment

    For each domain, consider your current level of satisfaction on a scale of -10 (completely dissatisfied) to 10 (completely satisfied). Slide the gray bar to the number which best reflects your predominant experience over the past couple of weeks.
  • Livelihood & Lifestyle

  • Body & Wellness

  • Learning & Creativity

  • Relationships & Society

  • Spirituality & Purpose

  • Current Challenges & Therapeutic Goals

    This section is designed to help us develop a shared understanding of your current struggles, as well as your vision for the future. This is just a starting point - we will continue to discuss and explore your answers in-depth during our sessions.

  • If you were going to narrow it down (for now) what would be the top three goals that you'd like to accomplish during the next three months? Please enter them (in order of priority) in the text boxes below.

  • Therapeutic History and Preferred Methods

  • I am certified and trained in a variety of specific modalities which are woven into our sessions to best meet your needs and preferences. In order to get a better idea of how to maximize our time together, please let me know what modalities are most (and least!) interesting to you. If you aren't sure or haven't heard of it - please select the "curious/unsure" column.

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  • Part of my session may include Hypnosis (with your permission). This is because the area we want to work with is your sub-conscious thinking and societal programming. Hypnosis allows you to connect there in a relaxed and safe environment. I guide you and you remain in control at all times. 

    Hypnosis is safe and again, you remain in control at all times. It is not like what you may have seen on stage shows and TV. 

    Hypnosis is effective with a large number of issues and areas. However, Hypnosis’ Practitioners do not under any circumstance, diagnose any illnesses or conditions nor do they purport to replace the treatment of a Medical Doctor (GP) or Psychotherapist. Should a Hypnosis Practitioner suspect that a client undergoing Hypnosis is suffering from an undiagnosed illness or condition, they would immediately refer the client to their primary care physician.

    ​Hypnosis cannot, and should not, stand alone as the sole medical or psychological intervention for any disorder. Hypnosis should not be used instead of appropriate medical, dental, or psychological treatment, and any individual with a medical or psychological problem must consult a qualified health care provider for diagnosis and professional advice. Hypnosis should only be practiced by those who have been appropriately trained, who practice appropriately, and within the scope of their training, rules, and legislation.

  • Client Participation

    • The client must consent to full participation in the therapy process, including listening to the audio download provided. 
    • Hypnotherapy is an effective method of treatment, however, success is not guaranteed and will only work with the client's full cooperation and the client acknowledges this.
    • Listening to the audio between sessions is a vital element in the process and participation is required. This will be fully explained in the initial consultation.
    • Results may vary from person to person. 
    • Should the client turn up to an appointment under the influence of drugs or alcohol, the therapist reserves the right to cancel the session and charge the full session fee. 

    After your initial appointment, you will be provided a secure link to our website. This is where you will see updated session notes, audio recordings will be loaded and documents you can download for the homework and self-care components. 

    This secure section of for you only. You agree to not share or distribute the information provided in this section to others. 

    If you choose the audio only option for sessions these are provided to you in an audio file via email. You will not have access to the secure area of the website. 

  • Coaching Terms and Conditions.

    Please review so you are fully aware of our partnership moving forward. 

    Client Agreement is between Deanna L. Byrne (Self Love & Confidence Coaching) and yourself [Named at the beginning of this form].
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    1. As a client, I understand and agree that I am fully responsible for my physical, mental and emotional well-being during my coaching sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time.

    2. I understand that coaching is a Professional-Client relationship I have with my coach that is designed to facilitate the creation/development of personal, professional, or business goals and to develop and carry out a strategy/plan for achieving those goals.

    3. I understand that coaching is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, education, and recreation. I acknowledge that deciding how to handle these issues, incorporate coaching into those areas, and implement my choices is exclusively my responsibility.

    4. I understand that coaching does not involve the diagnosis or treatment of mental disorders as defined by CMHA (Canadian Mental Health Association). I understand that coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment and I will not use it in place of any form of diagnosis, treatment or therapy. If I am currently receiving psychiatric care, I will consult with my caregiver to ensure working with a coach is in my best interest at this time.

    5. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law. I understand that if I reveal information that involves physically hurting myself or others, the coach must report such information and/or refer to mental health professionals accordingly.

    6. I understand that certain topics may be anonymously and hypothetically shared with other coaching professionals or clients for training, educational OR consultation purposes and that Deanna Byrne will take great care to change any identifiable details to protect my privacy.

    7. I understand that coaching is not to be used as a substitute for professional advice by legal, medical, financial, business, or other qualified professionals. I will seek independent professional guidance for legal, medical, financial, business, or other matters. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my sole responsibility.

    8. Because professional coaching is not considered medical consultation or treatment, health insurance does not apply.
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    9. I take full responsibility for my role in this partnership and will strive to meet all challenges, program outlines, and accountability timelines.
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    10. I agree to the financial investment outline for my sessions and will be provided to me prior to sessions starting. My session "action plan" will be determined and sent to me prior to committing to session appointments.

    11. I understand that each session must be pre-paid. In the event, I need to cancel or do not show up, that the payment refund policy will apply. 

    12. I understand that my session fees are non-refundable and If I choose to cancel my services, each file will be handled individually and any refunds determined at that time. There is an automatic $75.00 + HST administration fee deducted along with any session amounts based on a full session rate. 

    13. I understand that no session work or program handouts will be provided until payment in full is received. 

    14. I understand and agree that all tools, recording, workbooks etc are PROPRIETARY information and under copyright. No sharing, duplicating or making copies in any form is permitted. 

  • Payment Terms & Cancelation


    Session payments are required at the time of booking. We accept all major credit cards and e-transfer. We do not offer payment plans at this time. 

    Payments are non-refundable however will be used towards future appointments as per the criteria below. 

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    Cancelation Terms: 

    1. No-show appointments are 100% non-refundable.  
    2. 48 hours notice is required to cancel with the exception of a medical emergency. The investment will be used towards a future appointment. 
      Cancelation prior to 48 hours results in your investment being placed towards your next appointment. 
    3. Cancelations within 48 hours of appointment time are 50% non-refundable and applied towards your next appointment. 
    4. Membership fees require a six-month commitment at which time may be canceled with 30 days' notice. 
    5. Your appointment is not confirmed or held until payment is processed or received. 
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  • Disclaimer


    Hypnotherapy and Coaching is a non-regulated field within Nova Scotia. Deanna Byrne is certified and accredited in Hypnotherapy, NLP (Neuro-Linguistic Programming), and a Master Life Coach. Hypnotism is a self-regulating profession and its practitioners are not licensed by provincial governments. Deanna is not a physician nor a licensed health care provider and does not provide a medical diagnosis or recommend you discontinue any medically prescribed treatments. A client has a right to refuse hypnotherapy and coaching services at any time. A client has a right to know the expected duration of sessions prior to the commencement of treatment. Hypnosis is not guaranteed and its effectiveness is individual.
    Individuals under the age of 18 must-have parental or caregiver written consent and they are required to be in the room during any hypnotherapy. To review the Coaching Code of Conduct click here.

    Appointments are confidential however, in the event there is a fear of self-harm or harm to others, we have a professional obligation to contact appropriate professionals. In the event of a report of abuse to children, we are also obligated to report this to Child Protective Services. At which time your client file will be released to those appropriate professionals. 

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    If you have any questions, please feel free to e-mail me at info@deannabyrne.com or text me at 902-472-0592.

    I look forward to seeing your answers and connecting with you soon!

    IMPORTANT - please add info@deannabyrne.com to your email contact list. This will avoid our important emails from going to your junk/spam folders. Always keep an eye on those folders just in case. We don't want you to miss anything. 

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