Hypnocoaching intake form

Our journey together begins with this intake form. You will notice that this form may be different from others you have seen or experienced; It is designed to help you think about who you are, where you have been, what you value, and where you most want to go.

It is also designed to help me understand your world so that I can help you release past pain, live more fully and freely in the present moment, and create the future that you most deeply desire and deserve.

Take the time to think about these questions and answer in the most honest, open, and direct way that you can. Also, understand that some of these questions can elicit strong emotions, so take the time to complete them with an attitude of persistence, willingness, and confidence in the process.

Important note: You can save your questionnaire and come back to finish it when you can.

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First Name

Last Name

Email Address

Número de teléfono

Date of birth*

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What is the single most important change that you would like to make as a result of our work together?

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What difference will this change make in your personal life? Your professional life?

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What would double your level of happiness and fulfillment this year?

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What are your three most important goals for this year?

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What, if anything, is blocking your progress towards these goals?

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What would double your level of success this year?

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How often do you sacrifice what you really want in order to please someone?

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How often do you sacrifice what you really want in order to avoid threatening or intimidating someone?

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How often do you pretend that things are okay when you don’t really feel that way on the inside?

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What is the biggest lie you have been telling yourself?

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Which of your relationships are the most supportive and unconditionally loving?

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What brings you joy?

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What are the five emotions you feel most often on a day-to-day basis?

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What are the five emotions you would most like to experience more often?

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What are your greatest personal strengths?

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What are your greatest areas in need of improvement?

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Do you make most decisions based on rational deliberation, gut instinct, intuition, emotion, or some combination of these modes?

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What was your life like growing up? Your relationship with your parents and siblings?

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What was your experience of school like during your childhood years? As a teenager?

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To what degree do you currently feel supported in your personal and professional aspirations by your family and friends?

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Who (if anyone) is likely to be threatened by or resentful of your success?

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To what degree are you at peace with your past?

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What are the five emotions that were most commonly experienced and expressed in your household (by you and members of your family of origin) during your childhood?

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To what degree do you believe your past experiences continue to negatively impact your present life?

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To what degree do you believe your past experiences continue to positively impact your present life?

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How quickly do you tend to recover from emotional setbacks?

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How physically active are you?

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How well do you care for your body?

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Are you currently experiencing any chronic or reoccurring physical pain?

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How healthy do you feel?

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How well do you sleep?

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Are you experiencing any health problems?

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Do you have any physical symptoms that disturb you?

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What is the biggest source of stress in your life?

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What do you do to relax?

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What do you do for fun?

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What is your history of working with therapists, counselors, mental health professionals, and/or energy medicine practitioners?

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Are you currently taking any medications? If so, which ones?

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Are you now, or have you ever been in the past, suicidal?

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Have you ever received a diagnosis of any of the following conditions: anxiety disorder, attention deficit disorder, bipolar, borderline personality, depression, obsessive-compulsive, post-traumatic stress, schizophrenia?

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Do you or anyone in your family have a history of substance abuse? If yes, please specify.

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Do mental health issues run in your family?

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Do you (or did you ever) smoke? If yes, for how long?

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Do you have any other medical or psychological conditions of which I need to be aware?

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What excites you the most in relationship to our work together?

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The services that will be provided as a coach and clinical hypnotist will be carried out in person, by phone or by Zoom, previously agreed with the client. Angie Ramos can address issues such as specific problems, emotional wounds, skills development, areas of opportunity, or general conditions of the client’s life. Other coaching services include the clarification of ideas, changes in behavior and ways of thinking, identifying actions to take, evaluating the way in which they operate in their personal or professional life and making suggestions for the client to take action.

The client understands that Angie Ramos is a transformational coach who works with the subconscious mind and the stored emotions, she is not a doctor or psychologist and cannot diagnose diseases, prescribe or treat medical conditions or serious disorders. The client understands that this hypno-coaching session is not a substitute for normal medical care and it is recommended that they discuss this procedure with any physician treating them now or in the future. Additionally, the client should continue with any current medical treatment and consult her GP for treatment of new or old illnesses.

The client is willing to be guided through various methods, including relaxation, visual imagery, emotional detox, creative visualization, hypnosis, Neuro-Linguistic Programming (NLP), Rapid Emotional Release Techniques (EFT), Havening Techniques™, heart coherence as per HeartMath Institute, stress reduction for personal, professional or vocational improvement purposes. I also agree that Angie Ramos or I can end this relationship at any time and for any reason.

During this relationship, Angie will establish direct and personal conversations. The client understands that to have good results it is necessary to have a collaborative and co-active relationship between the client and the coach.

The client understands that coaching is not a substitute for professional legal, medical, or financial advice. All decisions made in these areas are the responsibility of the client.

In addition, you agree that the payment agreed for this session, the subsequent sessions (in case you want to continue the work) will have a cost of $ 120 USD for one session, which will last approximately 60 to 80 minutes. Alternatively, you can choose a package that includes 3 bi-weekly sessions of 60 to 80 minutes with a cost of 300 USD.

Additional appointments can be booked if necessary.

If you need to cancel an appointment, please do so within 24 hours, otherwise, the session will be charged.

Angie Ramos works within the code of ethics and guidelines designated by the International Coaching Federation and the Havening Institute.

All information about the client and the relationship between the coach and the client is kept strictly confidential.

I have read and I agree to the terms and conditions

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Hypnocoaching intake form

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