About this template
Streamline your client intake workflow with this comprehensive Hypnotherapy Client Information Form template, designed specifically for hypnotherapists, wellness coaches, and mental health practitioners. Gathering thorough client background before a first session is essential for tailoring effective treatment plans and ensuring client safety. This template collects critical details including contact information, emergency contacts, medical history, current medications, lifestyle habits, and primary therapeutic goals.
Built to save time and eliminate messy paper intake packets, this digital form allows new clients to share their history and preferences comfortably from any device before their appointment. With Doc2Form, you can instantly turn this structured layout into a ready-to-use Google Form, ensuring your client onboarding process is organized, professional, and entirely paperless from day one.
Key features
- Collect complete client history and contact details in one organized submission.
- Screen for medical conditions, medications, and psychological history safely.
- Understand client lifestyle habits, stress levels, and sleep quality.
- Identify specific fears, phobias, and clear goals for therapy.
- Fully customizable to include your specific practice policies and consent terms.
Use cases
New client intake for private hypnotherapy and wellness practices.
Pre-session health and lifestyle questionnaires for holistic practiti…
Pre-session health and lifestyle questionnaires for holistic practitioners.
Initial consultations for stress management and behavioral coaching.
Intake documentation for virtual or in-person therapy sessions.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)We will use this to send appointment confirmations and session resources.
- Primary Phone Number (Short answer)Enter the best number to reach you.
- Home Address (Paragraph)Provide your current residential address.
- Emergency Contact Name and Phone (Short answer)Provide the name and phone number of someone we can reach in case of an emergency.
- Employment Status (Dropdown)Select your current employment situation.
- How did you hear about us? (Dropdown)Let us know how you found our practice.
- Current Medical Conditions (Paragraph)Please list any diagnosed medical conditions or physical ailments.
- Prescription Medications (Paragraph)List any medications or supplements you are currently taking.
- Prior Psychological Therapy (Multiple choice)Have you previously attended counseling, psychotherapy, or hypnotherapy?
- Current Stress Level (Linear scale)Rate your overall daily stress level on a scale from 1 to 5.
- Sleep Quality (Linear scale)Rate your average sleep quality.
- Primary Therapy Goals (Paragraph)Describe what you would like to achieve or change through hypnotherapy.
- Specific Fears or Phobias (Paragraph)List any specific fears, habits, or phobias you wish to address.
- Audio Delivery Preference (Paragraph)Do you have a preference for the tone or style of guided relaxation used during sessions?
- Privacy Policy & Terms Acceptance (Multiple choice)I understand that hypnotherapy is not a substitute for medical treatment and agree to the practice confidentiality terms.
- Signature (Typed Full Name) (Short answer)Type your full legal name as your electronic signature.
- Signing Date (Date)Select today's date.
FAQ
How do I use this template for my practice?
Simply click to convert this template into a Google Form using Doc2Form. You can then customize any questions, add your practice branding, and share the link directly with your new clients before their initial session.
What kind of information does this intake form collect?
It collects essential contact details, emergency contacts, medical background, current medications, lifestyle habits like sleep and exercise, stress levels, and specific goals for hypnotherapy.
Can I edit or add questions to the form?
Yes! Once the template is in your Google Forms account, you have complete control to add, remove, or modify any questions to fit your specific practice requirements.
Is this form template mobile-friendly?
Google Forms automatically optimizes your questionnaire for all devices, allowing clients to complete their intake forms easily from their smartphones, tablets, or computers.
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.