Clinical Hypnosis and/or H-EMDR – Follow-up Clinical Hypnosis and/or H-EMDR – Follow-up (#14)Follow-up between sessions in clinical hypnosis or H-EMDRInformation about youPROVIDED IDENTIFICATION NUMBERThe problem worked onThe problem worked onPlease describe in the box below your experience with the treatment. What changes have you experienced since then?Your experience of the last time and changes sinceTo what extent are the symptoms still present in your life?– Select –Not applicable12345678910NOTE Lower numbers mean milder symptoms (better feeling) Higher numbers mean stronger symptoms (worse feeling)To what extent has the problem affected:Your social life– Select –Not applicable12345678910Your family life– Select –Not applicable12345678910Your sex life– Select –Not applicable12345678910Your spiritual life– Select –Not applicable12345678910Your memory– Select –Not applicable12345678910The sleep– Select –Not applicable12345678910Your appetite– Select –Not applicable12345678910Your job or schooling– Select –Not applicable12345678910Your concentration– Select –Not applicable12345678910Cause you worry– Select –Not applicable12345678910Cause yourself depression– Select –Not applicable12345678910Cause yourself anxiety– Select –Not applicable12345678910Cause physical symptoms– Select –Not applicable12345678910Caused you other problems? (and then what problem – fill in the field below)To what extent has it had an impact?– Select –Not applicable12345678910Something else or other problemsSubmit form
