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Regression Therapy Booking Form

Regression Counselling Form

Regression Therapy Counselling

Regression therapy is a holistic approach that delves into past experiences to address unresolved issues and promote healing and empowerment. Your responses will help us understand your needs and goals for therapy, allowing us to tailor sessions to support your journey towards emotional well-being and personal growth.

Have you heard about regression therapy before?

Yes No

On a scale of 1 to 5, how interested are you in exploring past experiences to address current issues and promote healing?

1 2 3 4 5

What specific issues or challenges do you hope to address through regression therapy?

Unresolved Trauma Behavioral Patterns and Habits Self-Exploration and Personal Growth Relationship Dynamics

Have you previously undergone any form of therapy or counseling?

Yes No

How would you describe your current level of emotional well-being?

Low Medium High

Are you open to exploring past experiences to gain insight into recurring patterns or behaviors in your life?

Yes No

How often do you meet with your advisor or counselor?

Regularly Occasionally Rarely Never

How comfortable are you with delving into potentially difficult or painful memories during therapy sessions?

Not comfortable Comfortable Very Comfortable

Are you interested in integrating mindfulness or relaxation techniques into your therapy sessions?

Yes No

How important is it for you to feel supported and understood by your therapist during the regression therapy process?

1 2 3 4 5

Would you prefer individual therapy sessions or group therapy sessions for regression therapy?

Individual Group No preference

What coping mechanisms or strategies do you currently use to deal with stress or emotional challenges?

Mindfulness and Meditation Physical Exercise Seeking Social Support Creative Outlets

Are there any specific goals or outcomes you have in mind for your journey with regression therapy?

Resolution of Specific Trauma Improved Self-Esteem and Confidence Enhanced Emotional Regulation Increased Clarity and Self-Understanding

How often do you experience feelings of burnout or exhaustion?

Frequently Occasionally Rarely Never

How important do you believe participating in regression therapy session is?

Not important at all Somewhat important Moderately important Very important Extremely important

What is your email address?

What is your phone number?

Please select which of our Regression Therapy counsellors you would like to book a session with:

Enter PDF Link (optional):

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