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Before We Connect

Thank you for reaching out.
This short questionnaire helps me understand what you’re experiencing so our consultation can be focused, supportive, and meaningful.
There are no right or wrong answers. Share only what feels comfortable for you.

Pre-Consultation Questionnaire

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First Name

Email Address

Phone Number

What brings you here today?

Which area best fits what you want help with?

Anxiety or stress

Test anxiety

Performance anxiety

Confidence

Mindset reset / feeling stuck

Vaping or smoking cessation

Other

How long has this been affecting you?

Less than 3 months

3–12 months

1–3 years

More than 3 years

When you imagine this issue resolved, how would you like to feel?

On most days, how would you describe your stress or anxiety level?

Low

Moderate

High

Overwhelming

Have you tried anything to address this already?

Yes

No

If yes, briefly describe what you’ve tried

Have you experienced hypnosis or guided subconscious work before?

Yes

No

How open are you to exploring new ways of thinking or responding?

Very open

Somewhat open

Unsure

On a scale of 1–10, how ready do you feel to create change right now?

1 – Not ready at all

2

3

4

5

6

7

8

9

10 – Fully ready

Anything else you’d like me to know?

Hypnosis Works

Lasting change begins in the subconscious.

Home
Blog
About
Service
FAQ
Contact

Home
Blog
About
Service
FAQ
Contact