Home / Templates/ Healthcare/ Hypnotherapy Intake and Consultation Form

Hypnotherapy Intake and Consultation Form

Replaces the paper folder used at a first hypnotherapy appointment. It captures personal details, doctor and emergency contacts, medication, previous experience under hypnosis and the specific areas the client wants to work on, all signed online. Aimed at therapists who manage their own client list.

Use this template

Already have an account? Log in

Full Name*

Nombre

Apellido

Preferred Name

Date of birth*

Address*

Dirección

Ciudad

Estado / Provincia

Código postal

Phone Number*

E-mail

Relationship Status*

Occupation*

Emergency contact name and phone number*

Doctor's details - name, address and phone number*

Date of last check up*

Health background

Medications taken - please list below*

I have been hypnotised before*

Yes No

Please provide me with a bit more information if you HAVE been hypnotised before.