Margarita Bozhenkova
Margarita Bozhenkova
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NEW CLIENT INTAKE FORM
📌 Before booking your session, please take a few minutes to complete this form. Your responses will help me understand your needs and tailor the session for you. All information is confidential.
Full Name
Your email
Phone Number
Age
How did you hear about me?
Instagram
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Referral
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What motivated you to book this session?
What is the main issue or challenge you’d like to explore?
Have you worked with hypnotherapy or mind-body healing before?
Yes
No
If yes, what methods have you tried in the past?
What do you hope to gain from this session?
Do you experience any chronic symptoms or recurring emotional patterns?
On a scale of 1-10, how would you rate your current stress level? (Scale: 1 = No stress, 10 = Overwhelmed)
0
10
What are your biggest stressors or emotional triggers right now?
Are you open to exploring subconscious patterns and emotional connections?
Yes
No
Are you willing to engage in self-reflection and take responsibility for your healing process?
Yes
No
✅ I have read and agree to the Terms & Agreement before my session.
✅ I understand that this session is not a substitute for medical or psychological treatment.
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