Session intake

New session

Worksheet type

First name

Surname

Session date

Email address

Used to send Evidence of Change follow-ups later

Discomfort format

Discomfort

What is the discomfort - describe it

Out of 10

The 5 Whys

How does this impact you?

How does the above make you feel? Where do you feel it in your body? (3 emotions/statements)

How do you want to feel? What is the new action? What would your dream outcome be?

What is the purpose of that? And what would that give you?

Pain format

What is the physical discomfort?

Out of 10

What are the symptoms of the physical discomfort?

What is the current outcome of your situation due to the physical discomfort?

If you had to guess, what is a subconscious benefit (that may not make any sense) to having the physical discomfort?

How is it making you feel emotionally?

What are the negative emotion words?

Side of the body?

Age it started?

What were you doing....?

Outcome format

Desired outcome

Outcome format has no /10 score, that's expected

Say it out loud and breathe into your body, where do you feel it?

What is the purpose of that? And what would that give you? (x5 why's if appropriate)

How would this positively impact you? (x5 why's if appropriate)

How does the above make you feel by not having it? What 3 emotions come to your mind, or do you feel in your body?

Why does it make you feel that?

How do you want to feel? And why?

Picture this, when your outcome happens, what does it feel like, what are you doing? Why are you doing it?

Now go forward 6 more months, what are you doing?

Are you ready to release all resistance to become that version of yourself?

Asked before the session, different from the after-session resistance question

Before the session, continued

What new beliefs would you like to code? (Add power words and language patterns)

One per line, list every belief, don't summarise

After the session

You came in with this, how do you feel around it now?

Their immediate reflection, straight after the session

How can you test to see if Belief Coding® has worked?

What can you commit to do?

One per line, they'll be joined automatically

When can you do it? Date and time

Was there any resistance?

If yes, belief code the resistance

Tip: use your phone or laptop's voice-to-text to speak straight into any of these boxes.

Generate a client link

Send someone their check-in

Session ID

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