Hypnotic Guided Imagery questionnaireTell us about yourself and your goals! Name * First Name Last Name Email * Phone (###) ### #### Age Are you currently under the care of a doctor? Are you currently taking any medications? Do you have light epilepsy? What are some of your favorite hobbies? Do you enjoy your work? Are you satisfied with your income? Do you feel stress? In what situations do you feel the most stressed? Do you exercise? If so, how often and what types of exercises? Do you get angry often? Are you happy? (If not, why) What worries you the most? Generally speaking, do you feel confident? (If no, is there a reason why you don't feel confident?) Are there any areas where you would like to feel more confident? (Please explain) Are you currently in a relationship? (If yes, How long? If no, When was the last relationship?) What do you expect from hypnosis? Have you ever been hypnotized before? (If yes, what was the result?) Why did you choose hypnosis? How did you hear about us? What are your 3 biggest goals: What is the most important element in deciding to use our services? Effectiveness: Your results? Time: How fast you get those results? Service: How fast we respond to your needs? Affordable: What we charge? Comfort: How well taken care of you are? Reputation: Our positive reputation? What is your idea of an adventure? What is the most relaxing situation you have ever been in? What is your favorite memory? Have you ever had a guided imagery experience before? (If so, please explain) Thank you!