About this template
Gathering comprehensive client background information is essential for a successful hypnotherapy practice. This Hypnosis Intake Form template helps hypnotherapists, wellness coaches, and mental health professionals collect critical health history, lifestyle habits, prior therapy experience, and specific session goals before the first appointment.
Designed to streamline your client onboarding process, this form replaces clunky paper questionnaires with a streamlined digital experience. It covers everything from contact details and current medications to sleep patterns and family dynamics, giving you the complete picture needed to tailor your therapeutic approach. By capturing these insights in advance, you can make the most of your initial consultation and focus entirely on your client's needs.
With Doc2Form, you can instantly turn this structured template into a ready-to-use Google Form, customize the questions to match your practice, and securely share it with new clients via a simple link.
Key features
- Collect detailed health history and current medications safely
- Assess prior hypnotherapy experience and personal goals
- Gather family background and lifestyle information easily
- Streamline new client onboarding before the first session
- Fully customizable questions to fit your specific practice
Use cases
- New client onboarding for private hypnotherapy practices
- Pre-session assessments for wellness coaches and holistic healers
- Intake documentation for behavioral health clinics
- Remote consultations requiring advance client background details
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Birthdate (Date)Enter your date of birth (MM/DD/YYYY).
- Email Address (Short answer)Where can we reach you with appointment updates and resources?
- Phone Number (Short answer)Enter your primary contact number.
- Mailing Address (Paragraph)Enter your street address, city, state, and zip code.
- Gender (Short answer)Specify how you identify.
- Marital Status (Dropdown)Select your current marital or relationship status.
- Prior Hypnotherapy Experience (Multiple choice)Have you ever experienced hypnotherapy or similar sessions before?
- Hypnotherapy Goals (Paragraph)What are your primary goals or what would you like to achieve through our sessions?
- Primary Complaint or Challenge (Paragraph)Describe the main issue, habit, or challenge you are seeking help with.
- Fears or Concerns (Paragraph)Are there any specific fears, anxieties, or reservations you have about the process?
- Current Health Status (Paragraph)Describe your general physical and mental health at this time.
- Major Illnesses & Injuries (Paragraph)List any significant past surgeries, injuries, or chronic medical conditions.
- Current Medications (Paragraph)List any prescription medications, supplements, or recreational substances you currently use.
- Sleep Patterns (Paragraph)Describe your typical sleep schedule, quality, and any difficulties you experience falling or staying asleep.
- Height and Weight (Short answer)Optional physical measurements for your wellness profile.
- Family Background & Relationships (Paragraph)Briefly describe your relationship with your parents and siblings, if applicable.
- Current Occupation (Short answer)What is your current job title and work environment?
- Other Information or Concerns (Paragraph)Share anything else you would like your practitioner to know before your session.
FAQ
How do I share this intake form with my clients?
Once Doc2Form generates your Google Form, you can simply copy the sharing link and email it to your clients before their scheduled appointment, or embed it directly on your website.
Can I modify the questions on this intake form?
Yes! Because the template is built directly in Google Forms, you have full freedom to add, remove, or edit any questions to match your specific practice requirements.
Is this intake form mobile-friendly for my clients?
Google Forms are fully responsive by default, meaning your clients can comfortably fill out the intake questionnaire on their smartphones, tablets, or computers.
Where are the client responses stored?
All submitted responses are securely saved in a connected Google Sheets spreadsheet associated with your Google Form, making it easy to review client data before a session.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.