Follow-Up Questionnaire

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Progress Evaluation & Feedback
Thank you in allowing me to be a part of your transformation and healing journey! I would love to hear how you are doing since our session. Please take this time to reflect. It is a great way for you to see how far you've come! Your feedback also helps me become a better practitioner and help even more people.

Email *

What was going on in your life and how were you feeling when you decided to seek help from JoJo? *

Please be as specific as possible.

With focus on any physical or emotional changes, feelings towards yourself and others, breakthroughs, and any significant changes in your life, what has changed since you began working with JoJo and how are you feeling now? *

How do you feel finally coming to understand the root/reason for your issue(s)? *

What impact did the hypnotherapy session and our work together have on your life? *

Is there anything you are still struggling with? *

What advice would you give to someone who is struggling and considering working with JoJo? *

Would you recommend these services or refer someone you know to work with *

Yes

Required

Additional Comments/Feedback for JoJo

I would love to share the above feedback with potential and future clients. Your story will help inspire others and show what is possible by working with me. Your privacy is of the utmost importance. When I share testimonials on my website or social media, I use the client's first name, first initial of their last name, and their state or country (Example: Nontakorn R., Nevada). Personal information and details will NEVER be shared publicly. Please indicate whether or not you give me permission to share your feedback with others. *

Yes, you can share my feedback with my first name, last initial, and location.

Yes, you can share my feedback, but please remove identifying details (a pseudonym will be used if you select this option)

No, please do not share my feedback

Required

Would you be willing to send me a photo of you to go along with your testimonial/feedback? *

Yes, I will send a photo to admin@nontakornhypnotherapy.com

No, I will not be sending a photo.

Required

I have read and fully understand that by making a selection above, I have chosen to either allow or not allow Nontakorn Hypnotherapy to share my feedback with others based on the selection I have made. *

By checking this box, I understand I am eSigning this form, where I will receive a copy of my completed form via email for my reference and records.

Required

A copy of your responses will be emailed to the address you provided.

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