Client Intake Form

Spiritual

Date of Intake

Date of Session

First Name

Last Name

Age

Birthday

1) Do you have any questions about what hypnosis is or the overall process?

2) Describe what you hope to gain through this experience.

3) Have you had any prior formal Past Life Regression sessions? If so, how many? What was the overall outcome?

3) Have you had any prior formal Past Life Hypnosis? If so, how many sessions? What was the overall outcome?

4) Have you experienced spontaneous Past Life recall? Please describe.

5) Are you a healer? In what modalities?

6) Have you met or do you work with any of your Spirit Guides?

7) What questions do you have for your Spirit Guide, should you have the opportunity to ask?

8) What Present Life issue do you want to focus on with PLR? What issue are you now facing that is causing a significantly negative impact?

9) What are your feelings, thoughts and questions about that issue?

10) How long has this been an issue? Has it changed over time?

11) What information or theory do you already have about the cause or nature of your issue?

14) Do you have any other questions that you would like to have answered?

Thank you for submitting your Client Intake form.I'm looking forward to our session!