1. How long and how often have you experienced these issues?
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“I’ve experienced them occasionally over the past few days or weeks.”
“I experience them frequently and have for a few months.”
“They are constant and have been ongoing for years.”
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2. Have you tried other therapies, and how effective were they?
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“No, I’ve only read about or researched it online.”
“Yes, I tried therapy and felt significantly better.”
“Yes, but I don’t feel much different.”
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3. How much control do you feel over your situation?
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Please choose
“I’m mostly in control of things.”
“I try to manage, but it’s often overwhelming.
“I feel completely out of control and helpless.”
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4. How urgently are you seeking help, and are you ready to change?
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Please choose
“I’m not in a rush and am not ready for big changes.”
“I’d like help soon and am willing to work on change.”
“I need help urgently and am fully committed to making changes now.”
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5. What’s your goal for seeking therapy?
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Please choose
“To understand my issues better.”
“To find effective solutions that help me feel better.”
“To make long-lasting, transformative changes.”
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6. What’s your perspective on hypnotherapy?
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Please choose
“I’m not sure what it does.”
“I think it’s mainly for relaxation or woo-woo.”
“I believe it’s a science-backed, effective approach.”
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7. Are you interested in personal growth?
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Please choose
“No, I just need relief from my immediate issues.”
“Yes, it would be nice, but it’s not my main focus.”
“Yes, my issues are holding me back from achieving what I want.”
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