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How strong is it right now? 5/10

How should I call you?

A little more about this

Health context (optional)

How would you prefer to be assisted? Self-help resources Audio / playlists Hypnotherapy scripts Personal session with Alexandre

Colour game — Round 1. Tap the 8 colours in your preferred order. You don’t need to remember the order later.

Email

Phone

Colour game — Round 2. Same colours, tap again in your preferred order. Don’t worry about matching Round 1.

Additional personal information

Mental health check — over the last 4 weeks…

About how often did you feel tired out for no good reason?

About how often did you feel nervous?

About how often did you feel so nervous that nothing could calm you down?

About how often did you feel hopeless?

About how often did you feel restless or fidgety?

About how often did you feel so restless you could not sit still?

About how often did you feel depressed?

About how often did you feel that everything was an effort?

About how often did you feel so sad that nothing could cheer you up?

About how often did you feel worthless?

Phobias

Session preferences

Anything else? (optional)

I consent to the confidential storage of my responses for therapy purposes. I understand data is anonymised after the retention window. I understand this information may be used for therapy preparation. I am comfortable with hypnosis/trance work if appropriate.

Good Words .info – Feel Better, Make It Last

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