Elevate Coaching Pathway

Questionnaire

To make the most of our journey together, please take a few moments to complete this pre-consultation questionnaire. The more detail you provide, the better I can tailor our sessions to support your personal and professional goals. Your insights allow me to create a safe, focused space where we can work through any challenges and unlock your full potential as a coach. Thank you for sharing!

First name

Last name

Professional Background & Goals

Briefly describe your coaching experience and areas of focus.

What are your main goals for pursuing hypnotherapy?

Are there specific areas of personal or professional growth you’d like to address?

Current Challenges

What challenges are you currently facing in your coaching practice or personal life?

Have you noticed any recurring thoughts, beliefs, or patterns that feel limiting?

Desired Outcomes

What would a successful outcome look like for you after these sessions?

Are there specific qualities or skills you’d like to enhance (e.g., confidence, resilience)?

Previous Experiences with Therapy or Hypnotherapy

Have you tried hypnotherapy, BWRT®, or any other therapy modality before? If so, please share a bit about your experience.

Are there any practices you currently use to manage stress or personal growth?

Are you open to exploring both hypnotherapy and BWRT®, or do you have a preference?

Safety & Comfort Considerations

Do you have any phobias or specific fears (e.g., fear of water, stairs, or other elements)?

Are there any situations or environments that make you feel unsettled or uncomfortable?

Declaration & Understanding

Anything that is said or revealed in the sessions between us is privileged information and will not be disclosed to any outside party. The exception is if the information revealed includes disclosure of illegal, unethical or criminal activities. By agreeing to this document, you agree to abide by these Terms and Conditions. 1. I am participating in therapy by my own choice because I want to be here. 2. I understand that I am not a patient, but a co-operator in my therapeutic experience. 3. I acknowledge the futility of blame for both myself and for others. 4. I understand that my progress here involves how I care for myself physically, mentally, emotionally, and spiritually. 5. I understand that transformation is a process and that it can take time. 6. You agree to being hypnotised for therapeutic reasons - if part of my treatment plan.

Agree

Signature

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