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* 1. Contact Information

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* 2. Employed By / Marital Status / Religion:

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* 3. Education and Goals:

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* 4. Hypnosis experiences and Health:

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* 5. How would you like your life to have changed:

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* 6. Special interests, passions, hobbies, etc.:

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* 7. Prioritize list of challenges, number in order of how important to work on right now. Include every area, regardless of priority or timing if you want to work on it.  If you have any trouble prioritizing between two challenges ask yourself "If I worked on a but never worked on b I would ____ or if I only worked on b and never a then my life would be _____ " and which ever comes out stronger place above the other.  Will get clarification on questions that request more information during session. 

if challenge is not on your list at all check NA-this automatically puts these at the bottom and narrows your list. Don't worry about getting it perfect, close is good enough, if it is an issue have a number by it-once all items that matter have a number you can reorder.

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* 8. Rank the following life areas by placing your top area of challenges first and so forth.

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* 9. This questionnaire is designed to understand current challenges so a customized holistic program in hypno-coaching can be designed to get you from where you are in life to where you want to be. Fully in your power, realization, expression and fulfillment.  You will be contacted to set up a Life Guidance Discovery Session, to co-create a program and receive your first customized hypnosis with all your goals.  I understand this

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* 10. Anything other concerns, information you want to provide or ask that we can cover in our session?

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