Ascension Hypnotherapy & Wellness

LIFE HISTORY QUESTIONNAIRE

This form provides a deeper, more expansive understanding of your life experiences. Your answers help tailor your healing plan to your specific energetic imprint and subconscious conditioning.

Early Development

Were there any known issues at birth, during infancy, or in early childhood?

Family System

Describe your family structure growing up. Include relationships, roles, trauma, or attachment issues.

Trauma History

Please list and describe significant life events that you consider traumatic or impactful.

Behavioral Patterns

What repeating emotional or behavioral patterns have you noticed?

Spiritual Experiences / Beliefs

Have you experienced spiritual awakenings, energy shifts, visions, channeling, or vortex awareness?

Medical & Mental Health History

List any relevant diagnoses, medications, or treatment history.

Current Intentions

What do you want to heal, release, or realign through this work?