Light Manifestors

Releasing Trauma

Booking a session

Client Questionnaire for Trauma Release Sessions

1. Name *

3. Gender *

4. Email *

5a. Phone Number *

+1

5b. Telegram mobile number, if different than your mobile number

+1

5c Telegram Account Username

6. Occupation *

7. BACKGROUND. Briefly describe the traumatic experience or experiences you would like to address in these sessions. *

8. IMPACT OF TRAUMA: How has this trauma affected your daily life, emotions, or relationships? *

9. CURRENT SYMPTOMS: Are you experiencing any of the following symptoms related to the trauma? (Check all that apply below)

Anxiety

Depression

Flashbacks

Nightmares

Avoidance behaviors

Hypervigilance

Difficulty concentrating

Irritability or anger

Physical symptoms (e.g., headaches, stomachaches)

Other

If Other, please describe

10. PREVIOUS THERAPY OR TREATMENT: Have you previously received therapy or treatment for this trauma? If yes, please describe your experience. If No, type N/A *

11. COPING STRATEGIES: What coping strategies do you currently use to manage symptoms related to the trauma? *

12. GOALS FOR TRAUMA RELEASE SESSIONS: What specific outcomes would you like to achieve through these trauma release sessions? *

13. EXPECTATIONS: What do you hope to gain from participating in trauma release sessions? *

14. SUPPORT SYSTEM: Who is your primary support system (e.g., family, friends, therapist) during this process? *

15. ADDITIONAL INFORMATION: Is there anything else you would like your trauma release practitioner to know about your situation or preferences? *

Consent: By submitting the form and the answers to the questionnaire, you acknowledge that the information provided is accurate. Furthermore it means you have read, understood and agree with the "Terms & Conditions". We will send you a pdf version to sign and submit via email or Telegram. *

READ HERE the "Terms & Conditions"

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