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    Questionnaire

    What do you wish to gain from Hypnotherapy?
    What are your symptoms of your difficulty?
    Do you feel any other symptoms or issues related to this difficulty? Where do you feel them?
    Have you been hypnotised before?
    Do you visualise and if so, can you visualise in colour?
    What is your favourite colour and least favourite colour?
    Do you have any fears or phobias?
    Do you have any medical conditions?
    What if any prescription medications do you take? Do you use drugs or overdo alcohol to an excessive level?
    What allergies, if any do you have? Have you ever been diagnosed with Epilepsy?
    What is your Marital status? How do you get on with your wife/husband/children?
    How do you feel about touching people or people touching you?
    What are your hobbies/interests?
    Do you have contact lenses?
    What is the safest and most peaceful place you could imagine being?