A comprehensive intake questionnaire to develop a personalized hypnotherapy treatment plan addressing anxiety, stress, depression, low mood, trauma, PTSD, relationship difficulties, self-esteem, confidence, personal development, and performance enhancement.

Introduction

Every person is unique. Two people may experience similar symptoms but for completely different reasons. Professional hypnotherapy is therefore never a “one-size-fits-all” process. A thorough assessment helps identify the emotional patterns, beliefs, memories, coping mechanisms, strengths, and goals that will shape an individualized healing program.

The following questions are designed to help both the therapist and the client gain clarity before beginning therapy.

Presenting Concern

1. What brings you to hypnotherapy today?

What is the main difficulty you would like help with?

2. If this problem completely disappeared, how would your life be different?

Describe what success would look like for you.

3. How long have you been experiencing this problem?

Did it begin gradually or after a specific event?

4. How severe is it?

On a scale from 1–10, where 10 is the worst imaginable:

  • Anxiety
  • Stress
  • Depression
  • Confidence
  • Emotional wellbeing

Emotional Experience

5. What emotions do you experience most often?

Examples:

  • Fear
  • Sadness
  • Anger
  • Shame
  • Guilt
  • Hopelessness
  • Loneliness
  • Numbness

6. What situations trigger these emotions?

Describe specific people, places, conversations, memories or situations.

7. How does your body react when these emotions appear?

Examples:

  • Racing heart
  • Tight chest
  • Sweating
  • Trembling
  • Difficulty breathing
  • Stomach discomfort
  • Muscle tension

Stress and Anxiety

8. What causes you the greatest stress at present?

9. How do you usually cope with stress?

Examples:

  • Avoidance
  • Working harder
  • Isolation
  • Food
  • Alcohol
  • Smoking
  • Exercise
  • Prayer
  • Talking

10. What worries occupy your mind the most?

Trauma History

11. Have you experienced any traumatic events that continue to affect you today?

Only share what you feel comfortable discussing.

12. Do certain memories still create intense emotional reactions?

13. Do you experience any of the following?

  • Flashbacks
  • Nightmares
  • Hypervigilance
  • Emotional numbness
  • Avoidance
  • Panic attacks

Self-Esteem and Identity

14. How would you describe yourself?

15. What do you believe are your greatest strengths?

16. What negative beliefs do you have about yourself?

Examples:

  • I’m not good enough.
  • I’m unlovable.
  • I always fail.
  • I don’t deserve happiness.

17. If you could completely change one belief about yourself, what would it be?

Relationships

18. How would you describe your current relationships?

Family

Partner

Friends

Work colleagues

19. Are there any relationships causing emotional pain?

20. Do you find it difficult to trust others?

If yes, why do you think that is?

Mental Wellbeing

21. What thoughts repeat themselves most often?

22. What gives your life meaning and purpose?

23. When do you feel happiest and most at peace?

Personal Development

24. What personal goals would you like to achieve over the next year?

25. What habits would you like to change?

26. What new habits would you like to develop?

Performance

27. Is there an area where you want to perform better?

Examples:

  • Sport
  • Public speaking
  • Business
  • Leadership
  • Parenting
  • Studying
  • Creativity

28. What currently prevents you from performing at your best?

Previous Healing

29. What have you already tried to improve your wellbeing?

Examples:

  • Counselling
  • Therapy
  • Medication
  • Coaching
  • Meditation
  • EFT
  • Prayer
  • Self-help books
  • Exercise

What helped?

What did not help?

Future Vision

30. Imagine yourself one year from today.

You have successfully completed your healing journey.

Describe in as much detail as possible:

  • How you think
  • How you feel
  • How you behave
  • Your relationships
  • Your confidence
  • Your daily life
  • Your physical wellbeing
  • What makes you proud of yourself

Therapist Notes

Following these questions, the hypnotherapist can identify:

  • The client’s primary presenting problem
  • Root emotional drivers
  • Limiting beliefs
  • Core fears
  • Protective coping mechanisms
  • Trauma history
  • Emotional triggers
  • Relationship patterns
  • Personality strengths
  • Internal resources
  • Motivation for change
  • Readiness for hypnosis
  • Desired therapeutic outcomes

This information can then be used to create a tailored hypnotherapy program that may include:

  • Clinical hypnosis
  • Ego strengthening
  • Inner child healing
  • Trauma-informed interventions
  • Regression (where appropriate)
  • Cognitive restructuring
  • NLP techniques
  • Guided imagery
  • Relaxation training
  • Mindfulness
  • Emotional regulation strategies
  • Confidence and performance enhancement
  • Future pacing
  • Self-hypnosis training
  • Relapse prevention and long-term maintenance

Closing Reflection

Healing is not about becoming someone else—it is about rediscovering the person you were before fear, pain, trauma, or limiting beliefs shaped your view of yourself and the world. Every answer in this questionnaire offers valuable insight into your unique experiences and strengths. Together, these responses help create a safe, compassionate, and individualized path toward healing, resilience, confidence, and lasting personal growth.