Client Intake FormAll information shared here and in the session is completely confidential. Name * First Name Last Name Email * Phone * Country (###) ### #### Date of Birth * MM DD YYYY How did you hear about Genesis | Sacred Beginning? Have you done guided hypnosis before? Yes No If yes, how was the experience? Do you practice any of the following altered states of consciousness? Check all that apply. Meditation Yoga Self Hypnosis Reiki What is your intention for this hypnosis session? * Are you currently undergoing any physical, psychological, or emotional treatments for the reason(s) you're seeking hypnosis? * Yes No If yes, please explain. What environment makes you feel safe and calm? Check all that apply. * Summery Beach Cozy Cabin Enchanted Forest Sacred Temple Restorative Mountains Magical Garden Revitalizing Pond, Lake or Stream Other When reminiscing about an amazing trip, what aspects come to you more distinctly? Check all that apply. * The sights, scenery, colors and beauty. The music, relaxing sounds of nature, birds chirping, ocean sounds. The amazing food and tasty drinks. The feeling of sand between your toes, wind in your hair, massages. The sensation of relaxation, excitement and joy. Which of the following terms resonates with you? Check all that apply. * Spirit Guides/Spirit Team Angels The Univers God/Goddess Source None Other Is there anything else that I should be aware of that will help in preparation for the session? By checking the box below, I indicate all information above is true and complete. * I agree Electronic Signature (Name, Date) * Thank you!
