Hypnotherapy Client Intake Form

Hypnotherapy Client Intake Form

Last updated September 4th, 2023

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A hypnotherapy client intake form is used to obtain background information from clients before receiving hypnosis treatment. The intake form reports the client’s personal and contact information, as well as other relevant details such as current medications, fears, phobias, mental illnesses, and any goals they hope to fulfill through hypnosis. Capturing this information helps hypnotists and hypnotherapists understand each client’s unique requirements and ensure that treatment is provided safely and effectively.

Licensing Requirements

Hypnotherapy is generally an 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.


Hypnosis vs. Hypnotherapy

Hypnosis is a form of guided relaxation where an individual enters a trance-like state of focused attention and increased suggestibility. It’s a method that can be used for a number of reasons, including habit control, stress alleviation, or improving performance.

Hypnotherapy is a therapeutic treatment that uses hypnosis to impose behavior and psychological changes. Hypnotherapists usually work in a clinical setting and are trained to help clients through specific emotional issues and personal challenges. A physician’s referral is often needed to receive hypnotherapy.

Hypnotherapy Intake Process

Below is an overview of the intake process for hypnotherapy clients, including how the intake form can help get the correct information and create a customized treatment plan.

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 with a request that it be filled out and returned before the first scheduled session.

Intake Form

With the intake form in hand, the new client can begin to supply their information. Individuals are typically asked to provide the following:

  • Contact Details – The client’s address, phone number, and e-mail helps facilitate communication for scheduling purposes.
  • Prior Hypnosis Treatments – Past hypnosis experiences will reveal previous successes or challenges and help avoid duplicating 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, monitor progress, and adapt the sessions accordingly.
  • Social Habits – Knowing whether a client smokes, drinks alcohol, or has other potentially unhealthy habits provides valuable insight into their lifestyle and possible influences on their overall well-being and objectives.
  • Medical HistoryBy communicating the client’s current medications and health conditions, the hypnotherapist becomes aware of any risks that hypnosis may impose.
  • Life Issues – Problems relating to family, relationships, work, and other life issues should be reported so that the hypnotherapist can offer relevant suggestions and treatment strategies.

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

First Session

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

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.