Anxiety and Stress Reduction 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 their particular situations or events you feel more anxious or stressed around?

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

Mind Trainer Signature

Client Signature *

Notes
*** The trainer is neither a medical doctor nor a psychologist and does not treat nor diagnose medical or psychological conditions. Progress reports may be sent to the attending doctor. *Sessions may be recorded for educational purposes

Stress / Anxiety Management

Stress and anxiety are at epidemic proportions in modern society and with the ever increasing overload of information we are bombarded with as a society, it is estimated to only become a greater issue.

Here at Mind Transformations we work with our clients through hypnosis to remove a lot of the negativity that holds them back from achieving their goals and that causes stress and anxiety day after day.

We do this by going into the subconscious mind of our client using hypnosis techniques and removing a lot of the unnecessary negative emotions that are attached to past events and causing anxiety.

Once this has been completed, we then work with our clients with anxiety to program in healthier, more goal orientated thoughts and beliefs to propel them towards a happier and more productive life with much less anxiety. Contact us for a FREE 30-minute consultation so that we can discuss how our hypnosis services can help you to reduce the stress and anxiety that you are feeling.

Anxiety and Stress Reduction Questionnaire

Stress / Anxiety Management

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