Hypnosis Questionnaire

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  Hypnosis Questionnaire Please fill out the following form, giving the first thought that comes to mind for each question. All information is kept strictly confidential.Today’s ate! .Age! #e$!  % &  % '(ccupation! &arital #tatus! .  : ).Have you ever *een hypnoti+ed o yes o no-.hat is your previous e$perience with and opinion a*out hypnosis .. . ./.Have you ever seen anyone hypnoti+ed o yes o no0.o you *elieve hypnosis can help you o yes  o no1.hat is the main goal that you would like hypnosis to help you with 2i.e., weight loss, smoking cessation3 . . ..4.hat are your smaller goals 25su*6goals73 that you want to accomplish to help you with your main goal 2i.e., quitting 8unk food for weight loss or handling stress *etter for smoking cessation3 9. Have you ever walked or talked in your sleep o yes o no:. Have you ever awakened like you couldn;t move or speak o yes o no<.Are you *asically a trusting person o yes o no)=.o you have a vivid imagination o yes o no)).o you daydream or involve yourself in fantasy o yes o no)-.Are you a*le to concentrate on an idea or thought o yes o no)/. o you feel comforta*le *eing touched *y someone you trust o yes o no)0. Are you open to new ideas  o yes o no)1. Are you a*le to follow directions o yes o no)4. Are you a*le to get in touch with your emotions easily o yes o no)9. o you *elieve that it;s possi*le for a person to *e healed *y the power of his or her mind o yes o no):. Have you ever wished that you could avoid taking any medication o yes o no)<. Are you *asically a religious or spiritual person o yes o no-=. Have you ever meditated o yes o no-). >f you were to imagine sucking on a sour, *itter, 8uicy, yellow lemon, would your mouth *egin to water o yes o no--. o you have nightmares o yes o no-/. Are you currently under the care of a Psychiatrist o yes o ?o -0.How strongly would you rate yourself from ) 2very weak3 6)= 2very strong3 with how well you feel you can engage in the following!a3@eing a*le to rela$ when you choose to   *3isuali+ing scenes or situations in your mind ..c3Becalling recent memories from the past d3Becalling distant memories from the past e3Telling yourself to do certain things in your mind .. Thank you for your time C Have a great day C
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