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I’m Sadhna Makhija, an International Trainer and Master Practitioner of NLP, Hypnotherapy & Time Line Therapy. Sadhna Makhija,Hypnosis,Hypnotherapy,Psychotherapy,Stress,Anxiety,Depression,Grief,Mentoring,Coach,Coaching,Fear,of,flying,Death,Public,speaking,Social,anxiety,Addiction,Smoking,Stop,smoking,Performance,Enhancement,Alcohol,addiction,Sleep,Disorder,Insomnia,Focus,Study,stress,Exam,stress,Weight,Weight,loss,Weight,management,Binge,eating,Emotions,Eating,disorder,Phobia,Anger,Grief,Sadness,Guilt,Shame,Loneliness,Dear,Frustration,Disappointed,Disappointment,Uncertainty,Confusion,Decision,making,Determination,Motivation,Therapy,Sessions,Cognitive,behavioural,therapy,Gestalt,Future,ADHD,PTSD,Trauma,Relationship,Teenage,Mid,life,crisis,Discomfort,Restless,Restlessness,Panic,Panic,attack,Self,respect,Awareness,Relaxation,Relax,Meditation,Peace,Calm,Rest,Confidence,Memories,Subconscious,Mind,Unconscious,mind,Feelings,Control,Skills,Believes,Limit,Coach,Coaching,Trainings,Irrational,Anchoring,Eye,patterns,Procrastinating,Procrastination,Strategy,Strategies,Past,Future,Pain,control,Tension,Headache,Dental,fears,MissionYou, Client,Intake form
Client Intake Form

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    Language Other than English

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    Emergency Contact Details:

    Questionnaire related to your Mental health:

    1. What are the some of the issues or concerns you would like to work on in therapy?

    2. Have you ever been given a mental health diagnosis?

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    3. Are you currently under the care of a psychiatrist, psychologist, case manager?

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    4. Have you experienced self-harm or suicidal thoughts?

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    If yes, when was the last time and is this currently occurring.

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    5. Are you currently on any stress anxiety or mental health medications? (Medication,Dosage,Frequency)

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    6. Do you consume any of the following? Drugs:

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    Cigarettes:

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    Alcohol:

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    7. Any Other Information on Addictive substances:

    8. Any Other Information / Notes / Observations:

    9. Fears and Phobias:

    10. Compulsive habits:

    11. Do you suffer from asthma or allergies?

    12. Have you ever suffered from depression?

    13. Have you suffered from epilepsy in the last two years?

    Your Signature:


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