Client Questionnaire Name * First Name Last Name Email * Phone (###) ### #### Date of Birth * Emergency contact person (name and phone number) * BACKGROUND INFORMATION What is your current occupation, and how do you feel about it? * Can you briefly describe your family situation? * What are your hobbies or interests outside of work? HEALTH & WELLNESS How would you describe your current physical health? * Are you currently experiencing any chronic pain or physical discomfort? If yes, please describe. * How would you describe your current emotional or mental health? * Are you currently taking any medications or undergoing other forms of therapy? * THERAPY GOALS AND EXPECTATIONS What are your main reasons for seeking RRT and/or hypnosis? * Have you undergone any form of therapy or counseling before? If yes, what type and what was your experience like? Are there any particular issues or areas of your life you wish to focus on or improve? * CONCERNS & PREFERENCES Do you have any concerns or apprehensions about undergoing our session/s? * Are there specific techniques or approaches you are interested in exploring? Is there anything else you think I should know about you to help us work together effectively? Do you have any questions for me about the therapy process or what you can expect? Thank you!
