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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?

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

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

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

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

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

    Cigarettes:

    Alcohol:

    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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