Hypnotherapy Client Intake Form

A hypnotherapy client intake form is used to obtain background information from clients before they receive hypnosis treatment. The intake form reports the client’s personal and contact information, as well as other details such as current medications, fears, phobias, mental illnesses, and any goals they hope to fulfill through hypnosis.

Hypnotherapy Client Intake Form

A hypnotherapy client intake form is used to obtain background information from clients before they receive hypnosis treatment. The intake form reports the client’s personal and contact information, as well as other details such as current medications, fears, phobias, mental illnesses, and any goals they hope to fulfill through hypnosis.

Last updated October 7th, 2024

A hypnotherapy client intake form is used to obtain background information from clients before they receive hypnosis treatment. The intake form reports the client’s personal and contact information, as well as other details such as current medications, fears, phobias, mental illnesses, and any goals they hope to fulfill through hypnosis.

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Licensing Requirements

Hypnotherapy is a generally unregulated profession in the majority of states. However, a license may be required if hypnosis is used in the treatment of:

  • Mental illnesses
  • Substance abuse
  • Panic attacks
  • Post-traumatic stress disorder (PTSD)
  • Insomnia
  • Phobias

Before treating clients with hypnosis, individuals are advised to contact their local licensing department to determine whether certification or licensure is required.

Hypnotherapy Intake Process

Below is an overview of the intake process for hypnotherapy clients.

1. Initial Contact

After an individual expresses interest in hypnotherapy or is referred to a hypnotherapist by a physician, they should immediately receive an electronic or paper intake form requesting that they complete and return it before the first scheduled session.

2. Intake Form

Clients are typically asked to provide the following information:

  • Contact Details – The client’s address, phone number, and e-mail.
  • Prior Hypnosis Treatments – Disclosing past hypnosis experiences helps avoid duplicating unsuccessful techniques or discussing topics that have already been explored.
  • Goals – Understanding what the client hopes to accomplish through hypnosis enables the hypnotherapist to address those goals directly and gauge progress.
  • Social Habits – Knowing the client’s habits can provide valuable insight into their lifestyle and possible influences on their well-being and objectives.
  • Medical HistoryThe hypnotherapist should be aware of the client’s current medications and health conditions to avoid any potential risks.
  • Life Issues – Problems relating to family, relationships, work, and other life issues should be reported so that the hypnotherapist can offer relevant treatment strategies.

Hypnotherapists will review the intake form before the initial session to familiarize themselves with the client.

3. First Session

During the first session, the hypnotherapist should have the intake form handy in case they need the client to clarify their goals, expectations, concerns, or other information initially relayed in the form.

4. Personalized Treatment Plan

Using the information obtained during the intake process and the first session, the hypnotherapist can create a personalized treatment plan. This includes the goals, techniques, and overall strategy for the upcoming sessions.

Hypnotherapy Client Intake Form (Preview)