Intake-Form

    Institute for Transpersonal Studies Rainya M. Dann Director

    Intake Form


    20 S. Santa Cruz Ave. Los Gatos, Ca. 95030

    420 Happy Valley Rd. Santa Cruz, Ca 95065

    Rainya@TranspersonalHypnotherapySchool.com

    Personal Information





    Please check what applies below & identify duration of time:

    1. What brings you to counseling at this time?

    2. In a few words, what will achieving your goals get for you?

    3. Are you currently in other counseling?


    4. Specify all medications you are presently taking and for what reason.

    5. Do you have any chronic pain, recurring body aches, or chronic medical conditions?

    6. Please share any present or past alcohol and/or drug history.

    7. Do you have suicidal thoughts?

    8. What spiritual resources do you have, if any?

    9. By what name do you call your spiritual support?

    10. What hobbies or interests do you have?

    11. What forms of exercise do you enjoy?

    12. In a world of limitless possibilities, how will your life look and feel when these issues are resolved?

    13. How did you hear about the work of Rainya Dann?

    14. Is there anything else you would like me to know?


    I understand the treatment received is for the purpose of stress reduction and personal growth.

    I understand that the hypnotherapist does not diagnose illness, disease, or any other physical or mental disorder, nor prescribe medical treatment or pharmaceuticals.

    It has been made clear to me that this hypnotherapy is not a substitute for medical examinations and/or diagnosis, and that it is recommended that I see a physician for any physical ailment that I might have.

    Because a hypnotherapist must be aware of existing conditions, I have stated all my known medical or mental conditions and take it upon myself to keep the hypnotherapist updated on my physical or mental health.

    With all this in mind, I agree to have hypnotherapy sessions and hold the hypnotherapist harmless for any problems that might arise as a result of the sessions.




    New Research on the benefits of Hypnosis and positive effects on the brain:



    https://search.app/9W7pHA4XEiAe7YG5A


    Thank you for taking the time to answer these confidential questions.
    It will support us in moving towards your goals more easily.