THERAPY SESSION REQUEST FORM with Linda *** Please erase everything below except your answers and the upper case topic before sending the form (to make it easier to read for me). Don't use word processor formatting, everything gets saved in a plain text file and that formatting will be lost. EMAIL Address : SKYPE ID: (REQUIRED) NAME: TIME ZONE & COUNTRY: OCCUPATION STATE/PROVINCE: GENDER: Male Female Transgendered AGE: AVAILABLE -What are your hours and days of availability for the next two weeks for an appointment? CURRENT SITUATION - Please describe your current situation, and why that leads you to request a session EXPERIENCE - Please describe your previous experience of trance or therapy if you have any (or other experience relevant to your request) What worked best, and what didn't seem to work so well? QUIZ - Please try the Hypno Quiz and report the results : GOAL - Please describe what your goal is, i.e. what you want to get out of the sessions. WHY - You've problaly had this problem for a while, so why is it important enough for you to want to change now? PROOF - Please describe in concrete observable terms how you will know when you've reached your goal. How will you know you've gotten the result you wanted? What will others observe of you once you have changed? (if you want to stop doing something, or stop reacting in a certain way, specify what you will be doing or how you'll be reacting after the change) The reason for this question is that some people do therapy with vague goals, get vague results, and don't know when to stop. If you can't imagine concretely what you'll be like after the change, that means your goal was too vague. On the other hand, if you have concrete goal, we'll be able to judge your progress by your answer here. THERAPIST - Please describe your ideal therapist / counselor / guide. What kind of person are you looking for? Someone serious? Humorous? Detached? Empathic? LIMITS - Describe the limitations you want on your requests:- Limits, things you don't want - Phobias or allergies you may have LETGO - How do you feel about letting go and allowing someone else be in charge for a short time.? No problem, I can easily let someone else take over for a while I can let someone else be in charge for a while if there's a good reason I'd really rather be in control. I find it difficult to let go. I need to always be in total control of what's going on. I never let go. ROOMATES - Are you living with other people? Yes No DEPENDANT - Do you have children or other dependants who might need your immediate attention during a session ? Yes No PARTNER - Do you currently have a sexual partner or spouse ? Yes No AFFORD - What can you afford ? Regular in person sessions (first session must be online or by phone to prove you are serious) Occasional in person sessions Regular phone sessions Occasional phone sessions Regular online sessions Occasional online sessions Just one session if I save up I can't afford anything... pretty please? EXTENSION - Session extension : If your session ends at a critical moment, and it would be better to continue a bit longer for better results (in trance, you probably won't be in a state to decide), would you agree to your session being prolonged by 15 minutes. 30 minutes. 60 minutes. as much as seems necessary. I don't want my session prolonged without being awakened and asked first. WEBSITE - Where did you hear about this website ? (if you did a search on search engines, I would like to know what you wrote in the search box to find me) WISH - What is your wish? (the brief version of your request) If you have not filled out all the sections, I will ask you to fill out the form again. Please do it right the first time. It is better to write more than not enough. By sending this, I freely agree to have the changework done as requested by Linda and I understand what that implies.