What is hypnosis & how does it work?

Check out these references to learn more about hypnosis & what to expect in your session

Want to better understand hypnosis & its benefits?

Read this article by Cleveland Clinic about hypnosis including myths & facts, and what to expect during a hypnotherapy session.

Hypnotherapy is not like stage hypnosis. If you've ever watched a stage hypnosis show, I highly recommend this article as it will alleviate fears and misconceptions about hypnosis.

🌈 Hypnosis myths & facts

Hypnosis & meditation are similar. Both involve an altered state of consciousness (often called a trance) but there are differences.

Meditation is focused primarily on awareness, observation, exploration, and discovery.

Hypnosis has many of those same elements and also layers in suggestions - directions for the subconscious mind that are geared toward change.

🌈 Hypnosis vs Meditation

Hypnotherapy: Weight Loss Intake Form

First name

Last name

Phone

All fields below this line are optional.

Provide as much info as you are comfortable giving.
If you're short on time, fill out what you can and we can finish any incomplete sections together at your appointment.

Birthday

Month

Day

Year

How long has achieving and maintaining a healthy or ideal weight been a challenge for you?

What's the longest period of time in your adult life that you were able to maintain a healthy weight?

Was there a specific time where you felt it was easy to maintain your ideal weight? When & why?

Which best describes your weight gain & loss PATTERNS?

It's unusual for me to carry extra weight - I can usually maintain my ideal weight within a few pounds, but recently gained due to life changes or emotional changes.

I fluctuate between losing, maintaining & gaining - a see-saw effect. I lose a few pounds, then gain a few back so I don't make much progress. Sometimes I can maintain for a period of time, but then I gain it back again.

I've tried losing for many years but I'm overweight more often than I'm at my ideal weight.

Other pattern or further explanation::

How many times have you tried to lose weight and then gained back most or all of it?

What HABITS make weight loss a challenge for you? (You may select more than one)

Unhealthy food choices (junk food)

Drinking excess calories (soda, juice, alcoholic beverages)

Binge eating or late night snacking

Overeating / large portion size

Eating too fast / Not realizing I'm full until I'm too full

Lack of exercise / Sedentary lifestyle or desk job

Lack of consistency or perseverance with healthy behaviors

Not paying attention to my eating habits (distracted eating due to TV, work, driving, etc.)

Other habits or further explanation:

What SOCIAL & EMOTIONAL FACTORS affect your weight? (You may select more than one)

Low willpower, too tempted by food

Easily influenced in social situations

Mood swings or depression

Can’t stick to a healthy routine

Fearful of being too thin or previous eating disorder

Feel insignificant when I am small in size

Lack of self-esteem or self love

Feeling rushed or stressed

Other or further explanation:

Do you experience strong or frequent CRAVINGS for the following? (You may select more than one)

Which of your FAMILY members have struggled with weight? (You may select more than one)

What FAMILY TRENDS do you notice with regard to food & eating habits?

Has being overweight caused/exacerbated illnesses or injuries for you or your loved ones? (i.e. diabetes, heart disease, high blood pressure, joint problems, back or foot issues) What genetic or family-trend concerns do you have about weight?

As a kid, what were you TAUGHT about food, exercise & weight by your family or influential people (like teachers)? Or what did you LEARN, infer or assume? Note your earliest memories & feelings about food, exercise & weight.

Maybe you were told, "Clean your plate or no dessert", "Kids in _ are starving" or "Broccoli is good. Cake is bad." Or maybe you heard your parents or siblings say, "I'm so fat" or "Does this make me look fat?" Did you hear a parent encouraging (or insisting) that the other parent needed to lose weight or siblings teasing about weight? Maybe a traumatic moment made you want to be bigger so you could protect yourself.

What nutrition & exercise programs have worked for you in the past? Note your successes and how long it worked for you. Or what program do you plan to follow this time?

Looking back, why has this plan not worked long term? Or if you're still on the plan now, why is it not working for you as effectively as before?

What components of EXERCISE programs have helped you in the past? If you've never tried a program before, what do you think would match your personality & lifestyle?(You may select more than one)

Intense exercise: HIIT, Pilates, weight training, etc.

Lifestyle exercise: walking the dog longer, parking the car further from the store, taking the stairs instead of the elevator, etc.

Fun ways to exercise: swimming, playing basketball or soccer, hula hooping, skipping rope, etc.

A gym membership so I'll have access to equipment & amenities and have a dedicated time/place to exercise (at home I'm too distracted with other tasks or tempted to skip exercise in favor of the couch or bed)

A class or team (aerobics, tennis, dance, community activity, etc.) or exercising with a friend helps to keep me accountable & schedule my fitness

How will you know when you've achieved your ideal weight goal? Will it be a number on the scale, a size on your clothing?

When were you last at this ideal weight? Do you have a picture of yourself at this weight?

How do you plan to measure your progress? What milestones will you use and how will you celebrate each milestone?

What is your plan for mistakes and setbacks? How will you "fail forward" and be resilient, perseverant and persistent? (Don't worry, you don't have to be perfect to succeed!)

How will you feel when you reach your goal? How will you celebrate your success?

What is your "BIG WHY"? Why do you want to lose this weight? What physical, mental, emotional, social & spiritual benefits do you want?

You understand and agree that weight loss hypnosis is a powerful mindset tool that is ONLY effective when used in conjunction with healthy eating and exercise. You acknowledge that it's not a magic pill or magic spell. But it is magical what hypnosis can help you achieve when you break through subconscious blocks and use the power of your subconscious mind for inspiration, motivation & rediscovering your best self!

You understand that results and timeframes vary. Some people need only one session to reach a goal, while others need multiple sessions. Some people begin having success right away. Others notice their progress weeks later as small habits begin to accumulate and gain momentum. Please be patient with your results and consider whether more sessions may benefit you. Specific results cannot be guaranteed, but support and future suggestions for your success is guaranteed. Your success is my success.

Notes & Questions

90 min Hypnotherapy Session: Weight Loss $150

What is hypnosis & how does it work?

Hypnotherapy: Weight Loss Intake Form

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