Volunteer for Serenova Hypnotherapy

Volunteer for Serenova Hypnotherapy

Thank you for your interest in a pro bono hypnotherapy session with me. I am Tracy Bay, Practicing Behavioural Hypnotherapist, practicing under London College of Clinical Hypnosis Asia, currently fulfilling my clinical hours before opening Serenova Hypnotherapy as a paid practice. I'm based in Singapore, and all sessions are held via Google Meet. This form helps me understand your situation before we meet so I can prepare properly. These are real therapeutic sessions, not demonstrations. This form helps me get to know your situation so I can show up prepared for you. Everything you share, here and in session, is strictly confidential. Before your session, you will be asked to sign a consent agreement. Please answer as openly as you can — there are no wrong answers.
Name

First NameLast Name
Email
example@example.com
Contact Number

Country CodeArea CodePhone Number
Country
What would you like to work on?
Age
How long have you been dealing with this?
Describe the habit or anxiety pattern or phobia you want to address

Describe as clearly as possible 0/250
Are you currently seeing a psychiatrist, psychologist, or counsellor?
If yes, please make sure that they are aware you are seeking hypnotherapy
Have you ever been diagnosed with any of the following? (tick all that apply)
Are you currently taking any medication for mental or physical health?
Are you currently experiencing any of the following? (tick all that apply)

Other
Have you experienced hypnotherapy before?
Appointment Slots
Please download the form, sign and agree to the consent form and upload it before proceeding.
Upload of consent form

You may email me the signed form if unable to upload
Cancelof
Confidentiality Note

Clinical Supervision

As part of professional development, session content may be discussed in general terms with a clinical supervisor. No identifying information will be shared. Your name and personal details will not be disclosed.

Session Recording

Sessions may be recorded via audio for clinical supervision purposes only. Recordings are stored securely and deleted after the supervision session. Your consent for recording is sought separately below.

Pro Bono Acknowledgement

You understand this session is provided free of charge as part of the practitioner's clinical training hours. This does not affect the quality or confidentiality of the session.

Your Rights

You may withdraw from the session at any time without obligation. You may request that your intake information be deleted at any point by emailing me directly.
Confidentiality Agreement
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