15. Adult Continue Return Intake
This document provides an example of the Adult Continue Return Intake Form used by Norwest Wellbeing. It’s designed to give you an overview of the information we collect during follow-up sessions for adult hypnotherapy services.
Purpose of this Example:
- To familiarize you with the types of questions asked in our ongoing therapy process.
- To help you prepare the information you might need when filling out the actual form.
- To demonstrate our commitment to tracking your progress and tailoring our approach to your evolving needs.
Please note:
- This is a sample form and not for actual submission.
- The actual form will be provided to you directly before each follow-up session.
- All questions are carefully chosen to help us provide the most effective and personalized ongoing hypnotherapy experience for you.
Now let’s break down the form into its sections:
1. Personal Information
Description: This section verifies and collects basic details about you to ensure accurate records.
- First Name
- Last Name
- Mobile Number
2. Progress Assessment
Description: This section focuses on understanding your progress since the last session.
- What progress have you noticed since your last session?
- On a scale of 1-10, how would you rate your progress towards your original goal?
3. Current Focus
Description: This section helps identify the areas to concentrate on in the upcoming session.
- What aspects of your previous issue would you like to focus on in this session?
- What specific goal would you like to achieve in this upcoming session?
4. Self-Practice and Techniques
Description: Tell us about your experiences with the techniques we’ve used in previous session(s).
- Have you been practicing self-hypnosis or other techniques we gave you in previous sessions? If yes, how has that been going?
- Is there any particular technique or approach from your previous session(s) that you found especially helpful or would like to explore further?
5. Life Changes and Additional Information
Description: This space is for sharing any significant life events or additional thoughts.
- Have there been any significant changes in your life since the last session? (e.g., health, work, relationships)
6. Medical and Health Information
Description: This section helps us understand your overall health and wellness. Your physical health can significantly impact your mental well-being, and vice versa.
- Has any of your medical information changed since your previous session?
- Is there anything else you think would be important for your therapist to know?
7. Terms and Conditions
Description: This section ensures that you have read and agreed to the necessary policies.
- Terms and Conditions agreement checkbox