How are we going to help you?

(Think about what has led to you seeking this ‘Getting On Track’ course and write down the main reasons)

What would like to achieve by completing this course?

(hopes, dreams, aspirations, needs, wants, lifestyle shifts, feelings, emotions)

Do you consider you have any mental health issues? (Depression, anxiety disorder, bipolar disorder, eating disorder, suicide attempt, etc.)

Do you consider yourself “stressed”?

What are the biggest stressors in your life?

What do you do for stress relief?

What is your mood like most of the time?

How do you spend most of your time during the day (i.e. career, studying, parenting, volunteer work, etc.)? Do you have a job? Are you a fulltime parent? (Does this area of your life bring your satisfaction, indifference or concern?)

Do you feel in touch with your life purpose? Can you describe what this is?

What would you do if you could wave a magik wand?

What are your natural gifts, skills attributes?

Do you do anything to be in service to others? If not, would you find this life enhancing?

Do you feel financially secure?

Have you got a good relationship with money?

Who were you brought up by?

Have you got brothers or sisters?

Do you have a good support network?

Are you close with your family of origin? If not, why not?

Have you ever been in an abusive relationship or been a victim of rape, molestation, or incest? (Do you think you have recovered and moved on from this in a healthy way?)

What is your marital history? Are you married/divorced/committed but not married/single?

If you are in a romantic relationship, do you feel happy and connected in your relationship? If not, why not?

(Does your status bother you or cause you any distress?)

If you are in a sexual relationship, does your relationship satisfy you intimately and sexually?

Have you got children?

(Does this area of your life effect you in any negative way?)

Do you suffer from IBS?

Do you have migraines or headaches?

Do you check things too much?

Do you bite your nails?

Do you drink alcohol? (if so, do you consider you drink too much?

Do you smoke?

Do you have any problem with alcohol or drugs, now or in the past?

Do you have a balanced healthy diet?

Have you got any irrational fears: Height, Enclosed Spaces, Snakes, Spiders?

Have you ever had a Panic Attack: (fast heartbeat, hot / cold flushes, fast breathing?)

Do you have difficulty getting to sleep?

Do you wake up during the night:

Do you wake up too early?

Do you have difficulty waking up?

How many hours do you sleep?

On a scale of 1 to 10, with 1 being “exhausted” and 10 being “very energetic,” what is your general energy level?

What  hobbies & interests are you enjoying currently?

(Are there things you used to enjoy but stopped doing? Or anything you have always wanted to do but haven’t got round to it?)

Do you express yourself creatively? If so, how?

Do you have creative aspirations you would like to explore and develop?

Do you exercise? How often and what type?

Are you on any Medication?

Have you any other comments or information regarding your health that it would be useful to record

(Other Health Issues or Concerns you are currently dealing with or you have had in the past)

Are you happy with your weight, or do you wish to lose or gain weight?

Do you now or have you ever had issues with eating disorders, binge eating, or other eating compulsions?

Is anything keeping you from being the most authentic, vital YOU? If so, what is holding you back?

Is there anything missing from your life? If so, what?

What do you celebrate about yourself and your life?

Do you believe you can heal from whatever is holding you back—or do you have limiting beliefs?

If you are battling health issues, what does your body need in order to heal?

Do you nurture your spiritual side? If so, how?

Do you feel connected to a higher energy? If not, do you wish you did?

Are you happy to not think or consider a spiritual side to your life?

Do you live in a healthy, healing environment?

If you could change anything about your living environment, what would it be?

Read this statement: I understand that I will achieve my goals if I positively engage with the process and the solutions that emerge, play the Neurofit MP3 every night and proactively find ways to practise Positive Thoughts, Positive Actions and Positive Interactions daily. I understand that these are all key elements of the healing process I commit to undertaking with the support of Alchemy Hypnotherapy.

If you’re ready to Be Your Own Alchemist and Get Yourself On The Right Track, sign your name as commitment and contract with yourself and let the Magik begin!


Look back through your form filling and make a note of any issues, negative areas or problems you have recorded. These will be the focus for the changes you can begin making to create a new you. You will naturally come up with solutions that you’ve decided you need solutions to. You will be writing your own prescription to ignite your natural brain chemistry, creating positive change!

If you think that you have identified any mental health, life challenges or goals that may need more support than this self-development online course offers, don’t forget we offer one-to-one online and face-to-face bespoke therapy.