Hello,

My purpose in this questionnaire is to get a more complete picture of you as a human being. To better assist you with my professional abilities, knowledge is essential, and every piece of information you feel comfortable sharing with me will enhance our sessions together and will greatly reduce the time needed to get your desired results.

Of course, if you feel uncomfortable with a question, do not answer it. There is no obligation or commitment in filling out this simple form. Answering any kind of question may give you some insights about your life and habits, the kind of knowledge that is always beneficial when you come to your session.

Now, before you start, I want you to understand clearly- I NEVER share your private information with ANYONE. Besides the fact that it's against the law, I respect your privacy and confidentiality is my first and most important priority. Only you can provide the permission to show this form or any other document in my office to someone besides you and I. Even my Staff Members don't have access to your private information.

Please take as much time as you need to fill out this form. I gave it to you to do it at home and/or in private so you won't have to spend our session time on standard forms. I will use this form to do my own homework before our next session, to make sure that you get the most out of our time together. My livelihood and income are dependent on my success with my clients, and that is how important your progress and improvement are to me.

If you feel the need of any kind to ask for assistance with a question, please do not hesitate to call me directly. I will appreciate your comments and suggestions as always.

With love and warm regards,

Adam Goodson
Impactful Changes Hypnosis
619.564.2322