Spiritual Hypnosis, Mentorship & Coaching Intake Form

Spiritual Hypnosis, Mentorship & Coaching Intake Form
Welcome! This form is designed to help me better understand your journey, your goals, and how I can best support you through spiritual hypnosis, mentorship, or coaching. Please take your time to answer the questions thoughtfully, as this will guide our work together and ensure that our sessions are aligned with your needs. All information shared will be kept confidential and used solely to tailor your experience.

Whether you're seeking deeper healing, self-discovery, or guidance along your spiritual and personal growth path, I look forward to exploring this transformative journey with you.
Personal & Contact Information
Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Occupation
Introduction and Intentions
Please introduce yourself and share a little about your journey.
What has brought you to this type of work, and what are your goals for working with Ruba?
What are your current areas of focus (spiritual growth, emotional healing, past life exploration, clarity on life purpose, etc.)?
Have you had any experience with spiritual or holistic therapies before? If yes, please briefly describe.
Service Preferences
Which of the following services are you interested in? (Check all that apply)

Scheduling an initial Discovery Call to see if we’re a good fit.Mentorship/coaching program.Group mentorship/coaching sessions.Individual hypnosis sessions (Introspective Hypnosis, Past Life Regression, Quantum Healing Hypnosis Therapy).Craniosacral Therapy (if applicable).Therapeutic bodywork.
Session Logistics
What type of session do you prefer?

In-person sessions.Virtual sessions via Zoom.Open to both in-person and virtual.
What are your preferred days and times for sessions/meetings? (Please be as specific as possible)
Commitment and Availability
What type of commitment are you ready for? (Choose your preference)

One-time session with the option to book more when needed.Beginner’s Positive Intelligence Program (8-week commitment).3-month commitment.6-month commitment.Open to ongoing mentorship and sessions.
Readiness and Expectations
What areas of your life do you feel are ready for healing, transformation, or deeper exploration?
What expectations do you have for the sessions and for our work together?
How ready are you to commit to the inner work required for transformation?

Completely ready and committed.Somewhat ready, but with some hesitation.Curious but not sure yet.
Health and Well-Being
Do you have any physical health conditions, medications, or emotional concerns that may be relevant to your sessions?
Are you currently on any medication for mental health (e.g., antidepressants, anxiety medication)?
Do you have any history of trauma that you would like to share (if comfortable)?
Preferences for Your Experience
How do you prefer to process information and experiences?

Talking and discussing.Writing and journaling.Meditation or reflective practices.All of the aboveOther
Referral and Resources
How did you hear about my services?

Personal referral.Online search.Social media.YouTube (@introspectiveodyssey)Other
Final Thoughts
Is there anything else you would like me to know before we begin working together?
Should be Empty: