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*** Click here to begin making your Survey! ***

* Please provide your name and address
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* What is your email address?
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* Please provide your phone number here.
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Please list the year of your birth:
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Would you prefer an online (ZOOM) or in office appointment? Please be aware there may be a long waiting list.
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* How did you first hear of me and my practice?
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* Have you ever done a past life exploration before?
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Are you or have you been in counseling with a therapist.
* What are your major goals in your past life exploration?
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My approach to past life exploration includes a hypnotic induction to open the channel. Check all that seem INCORRECT (NOT TRUE) to you. Add any comments or questions in the "other" box at the bottom of this question.
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Please provide any background that you are comfortable sharing here about yourself and your goals for past life exploration.
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Please check any fears you have.
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CLIENT "BILL OF RIGHTS" 

Please read carefully before you complete this intake form.

 

All conversations and transactions between hypnotist and client are confidential and will not be disclosed except by the client's written authorization.

The length, content and approach of each session are to be agreed upon prior to the hypnotic consultation. It is the client's right to know the estimated number of sessions recommended to achieve his or her goals. It is the client's right to file a complaint with the National Board of Hypnotists, Ethics Committee, Merrimack, NH as well as any state agency. It is the client's right to refuse any process by his or her own determination and to end hypnotherapy whenever he or she wishes with a pro-rated refund. It is the client's right to have the name of other practitioners in the community who may be available to work with him or her. Note: John Koenig is a Board Certified Hypnotist and is certified and trained to instruct new professional hypnotists (National Guild of Hypnotists).


John is a Board Certified Hypnotist and a Certified Hypnotist Instructor with the National Guild of Hypnotists.


He is not a medical doctor or licensed psychologist, psychotherapist, social worker, dietition or nutritionist and does not diagnose or treat any illness. He holds a Bachelor of Arts Degree in Psychology (Hofstra University, Hempstead, NY) and a Master of Arts Degree earned at the National University of Ireland (Dublin, Republic of Ireland).