Client Discovery Call Intake
Welcome.
Thank you for taking a moment to complete this form prior to your session. The information you provide helps create a safe, supportive, and personalized hypnotherapy experience.
Name
*
First Name
Last Name
Preferred pronouns
(optional)
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What would you like support with during our sessions?
*
What are your goals or intentions for hypnosis?
*
Have you practiced meditation before?
*
Please Select
Yes
No
Have you experienced hypnosis before?
*
Please Select
Yes
No
Is there anything important you’d like me to know before our call?
*
If you've experience hypnosis/meditation before, is there anything that has felt uncomfortable or unhelpful in past experiences?
Submit
Should be Empty: