The intake form is not paperwork. It is a diagnostic tool, a legal protection, and the first filter that tells you whether the person sitting in front of you is a candidate for Divine Healing Hypnotherapy or for straight clinical work. I have refined this form over fourteen years, and I treat it with the same seriousness I treat the induction itself. A rushed or incomplete intake leads to a confused session.
The top of the form is straightforward: name, address, phone, email, profession, age, marital status, health concerns, and medications. But pay attention to the email address. Make sure it is their personal email, not their work address. I made this mistake once early in my practice and sent a deeply personal session recording to a corporate server. The client was the IT manager, so he caught it quickly, but not every client is the IT manager. Business emails can be read by departments you will never meet. Ask.
The next section asks what they would like to accomplish today. This is your map, but hold it lightly. Most clients arrive with one stated issue and leave having healed something entirely different. Spirit has a way of redirecting. What the client writes here simply tells you where they think the door is. Your job is to find the actual door. I also ask whether they have prior experience with hypnosis, meditation, or vivid dreaming. People who dream vividly and remember their dreams in detail tend to go very deep, very fast. They are already fluent in the language of symbol and image.
If they mention hearing voices, or if they indicate they have played with Ouija boards or spirit boards, make a mental note. That is not a judgment. It is a clue. Those activities can open windows that let things in, and later in the course you will learn exactly how to handle that. For now, simply note it and move on.
The next section asks them to list any close family members, friends, or pets who are now deceased. This is one of the most important sections on the entire form, and I do not make a big deal of it when I review it with them. I simply ask them to fill it out and watch their reaction. I do not tell them why I am asking. If they knew they might visit with a departed loved one during the session, the anticipation would flood them with emotion before the induction even began. You want them calm when they enter trance, not weeping with longing. The form gathers the names quietly, and you will use them later, at exactly the right moment, when the client is already safe and deep.
Now we arrive at the gate itself: the spiritual belief section. The form asks one open question — What are your spiritual beliefs? (Not necessarily your religion) Check all that apply — followed by a list of checkboxes: God, Higher Power, Universe, Energy, Angels, Spirits, Jesus, Mother Mary, Buddha, None, Other. There is also a separate line for Souls, with a follow-up: If yes, do you believe our souls have had other lifetimes? I do not ask them to pick one. I ask them to check everything that is true for them. The checked boxes become my vocabulary for the entire session.
This is the part new practitioners miss, so read it twice. You use the client's exact words, not yours. If they check God, I bring God in. If they check Higher Power but not God, I never say the word God in the session — I say Higher Power. If they check Energy and Universe but nothing else, the session is led by Source energy and the Universe, and I do not import a deity they did not invite. If they check Jesus, Jesus is in the room. If they check Mother Mary, she is in the room. If they check Angels, I ask which ones — Michael, Gabriel, Raphael, a personal guardian by name — and I call those specific angels in. If they write a name under Other, like Maharishi or Krishna or Great Spirit, that is the name I use. I may not personally resonate with every name a client writes, but the session is not about me. Whoever they trust is who shows up.
The Souls line is the gate for past-life work. If they check Souls and answer yes to other lifetimes, past-life regression is on the menu for today. If they leave Souls blank, or check Souls but say no to other lifetimes, I do not offer past-life work in this session — not as a surprise, not as a gentle nudge, not at all. I stay in this lifetime, with Inner Child, RESET, the Clean-Out, and whatever spiritual figures they did check. Forcing past-life work on someone who does not believe in it produces either nothing or a fight, and both waste the session.
If they check None, or check nothing in the spiritual section at all, the window is closed for spiritual work today. You do not try to talk them into it, reframe it, or sneak it in under different language. You switch to clinical hypnotherapy and do excellent, life-changing work in that framework instead. Clinical is not a lesser modality. It is the right modality for the person in front of you, and knowing when to use it is the mark of a mature practitioner.
When I hand my client the form to fill out, I offer to get my client water with lemon, cucumber, mint, or anything that I have available. The water is a small kindness, but the real reason I offer it is so I have an excuse to leave the room. If I stay in the room while they fill out the form, they ask me a million questions and it takes them longer to complete the form. Time is of the essence. I give them five minutes of privacy, return, collect the form, and begin the pre-talk. The session has already started, and it has started in silence, in respect, and in their own unguarded words.
Practice
Print a copy of the belief-system checkbox list (God, Higher Power, Universe, Energy, Angels, Spirits, Jesus, Mother Mary, Buddha, Souls, None, Other). For each box, write the exact phrase you will use in a session when that box is checked — and the phrase you will NOT use when it is left blank. The point of the exercise is to train your mouth to follow the form instead of your habits.