Services: Weight Loss & Exercise | Smoking Cessation | Goal Achievement & Performance
Personal Growth | Stress Management | Overcome Fear | Improve Sleep | Manage Pain
Hypnotherapy for Writers | Hypnosis Workshops | Long-Term Hypnotherapy | Teen Mindset Coaching

Client History Form

There are three options for filling out the client history form:

1. You can click here to download the Microsoft Word version of the client history form. This has been set up for you to easily type in your responses. If time permits, you can email your responses to me as an attachment—ideally no later than the evening before your appointment. Alternatively, you may print the form and bring it with you to your appointment. Click here for the Client History Form for Minors.
   
   
2. You can click here to download the PDF version of the client history form. This form may be filled out by hand at home and brought to your appointment. Click here for the Client History Form for Minors.
   
   
3. If option 1 and 2 are inconvenient in any way, I will provide you with the form at the beginning of our first session, and you can fill it out at my office.

If you are seeing me for weight loss, please also fill out the Weight Loss Assessment Form below.

Weight Loss Assessment Form (Microsoft Word)

Weight Loss Assessment Form (PDF– 4 pages)
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© Susan Gold, Certified Hypnotherapist, 650.532-0509,122 2nd Ave., Suite 209, San Mateo, CA 94401. Located on the Peninsula of the San Francisco Bay Area. Cities nearby include: Foster City, Redwood City, Belmont, San Carlos, Burlingame, Hillsborough, Millbrae, San Bruno, Brisbane, and Pacifica. San Mateo is just 19 miles from San Francisco. | Contact |