CLIENT APPLICATION FOR HYPNOTHERAPY SERVICES

This application helps determine if hypnotherapy is the right fit for your goals, mindset, and healing path.

Why are you seeking hypnotherapy?

What outcomes would feel successful to you?

Do you have any concerns, fears, or hesitations?

Do you agree to commit to the process?

• [ ] Journaling or self-reflection after each session
• [ ] Completing integration practices and homework
• [ ] Being open to emotional or energetic content that may arise

Spiritual Orientation

Please describe your beliefs or experiences regarding Source, Spirit, soul journeys, or metaphysical perspectives (if any):

Signature

Signature: ____________________________      Date: ____________

Printed Name: ____________________________