Basic Information

First Name

Last Name

Date of Birth

Are you 18 or older?

Yes No — I have guardian consent

Email Address

How did you hear about Sarah?

What brings you here? In your own words — no need to be clinical about it.

What service are you interested in?

Hypnotherapy sessions 1:1 coaching Dreamwork Group program / workshop Not sure yet — open to guidance

Mental Health & Safety

The following questions help me make sure we're working together in the safest and most effective way. Certain conditions require specialized support — answering yes to some of these doesn't mean we can't work together, but it does mean we'll have a conversation about it first.

Are you currently, or have you ever been, diagnosed with any of the following? Select all that apply.

Schizophrenia or psychotic disorder Bipolar disorder Borderline Personality Disorder (BPD) Dissociative Identity Disorder (DID) or dissociative disorder Epilepsy or seizure disorder Active PTSD (currently destabilizing) None of the above

A note

If you selected any of the above, please don't worry — this simply means I'll want to speak with you before we schedule a session to discuss how we can work safely together, or whether I can refer you to someone better suited. Hypnotherapy can still be appropriate for many of these, with the right modifications.

Are you currently working with a therapist, psychiatrist, or other mental health provider?

Yes No I have in the past

If yes, are you open to Sarah coordinating with your provider if needed?

Yes No Not applicable

Are you currently experiencing thoughts of harming yourself or others?

No I have had these thoughts in the past, but not currently Yes — I would like support with this

If you are in crisis

If you are experiencing active suicidal thoughts or a mental health emergency, please contact the 988 Suicide & Crisis Lifeline (call or text 988), or go to your nearest emergency room. Sarah is not a crisis service.

Are you currently in an acute mental health crisis, or experiencing a major destabilizing life event? e.g. recent hospitalization, active psychosis, severe acute trauma

No Somewhat — I'd like to discuss Yes

Please list any current medications or write "none"

Hypnotherapy Readiness

Have you experienced hypnosis or hypnotherapy before?

Yes No

If yes, what was your experience like?

Do you have any concerns or misconceptions about hypnosis you'd like addressed?

Your Vision

If we work together and it goes really well — what does your life look like a year from now? Dream a little. What are you feeling? What's different?

Is there anything else you'd like me to know before we speak?

Investment range This is not a commitment — just helps me make sure I can support you well

$600 / month feels workable $1,500–$2,000 / month — I'm open to deeper commitment I'm honestly not sure yet Money is a significant constraint right now

Before webegin.

Before we
begin.