Anger Management Questionnaire

Date of 1st Consultation

Full Name *

Phone *

Email Address *

Address *

City *

State *

Zipcode *

Date of Birth *

Gender * MaleFemale

How did you hear about us? *

What is the name of your current GP?

Do we have your permission to contact them? * YesNo

Have you ever been hypnotised?

How was that experience?

Reason you are coming in for hypnosis (what do you expect to resolve?)

How long have you had this issue?

Any previous attempt to address this issue? YES/NO Results?

Are you currently undergoing medical or psychological treatment for the above issue?

Are you currently taking any medications? Medical conditions? (Seizures, epilepsy, etc.?)

Are there particular situations in which you experience the feeling of anger?

Is there anything else would like to add before we start our sessions?

Mental Coach Signature

Client Signature *

Notes
*** The trainer is neither a medical doctor not a psychologist and does not treat nor diagnose medical or psychological conditions. Progress reports may be sent to the attending doctor. Any persons who is currently working with a licensed professional (therapist, psychologist, MD, social worker) must get a written referral.
* Sessions may be recorded for educational purposes

Anger Management

The feeling of anger is a natural human emotion. When the anger is healthy , it has the ability to allow us to stand up for ourselves when the going gets touch . Problems arise when the anger manifests to the point where it cant be controlled and leads to aggression and violence.

An inappropriate level of anger and the behaviours that follow can lead to hurting loved ones and work colleagues and can have a detrimental effects on health and our ability to connect with people around us.

Anger Symptoms

Violence and Aggression towards others
Relationship problems and break ups
Emotional and Verbal Outbursts
Impulsive and Dangerous Acts
Using drugs and alcohol as a coping mechanism to name a view
Critical and Overly controlling behaviour
Headaches , Stress , Anxiety ,
Self Pity , Guilt and lowered Self esteem

At Mind Transformations we provide a variety of techniques to clear out the negative emotion that has been triggering feelings of anger. After lowering the anger and stress levels in general, we work on showing you a number of scientifically proven techniques to be able to manage anger before it reaches high levels.

Anger Management

Anger Symptoms

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