INNER RECODE SESSION QUESTIONNAIRE

This is a 90-minute 1:1 neurocoaching session. We go directly to the level where the pattern runs and begin to update it, below the self-awareness, below the effort, below the very articulate description of why you keep doing the thing.

The more context you give me, the more precisely we can work.

If a question doesn't resonate, skip it and share whatever feels important for me to know instead.

First Name

Last Name

Phone *

Email *

What is your main goal or block for this session—the thing that feels most pressing right now?

When you think about this goal or block, what words or phrases run through your mind? If you could write down the ‘headline’ your inner critic gives you, what would it say?

What emotions come up—both the surface ones (like frustration, anger) and the quieter ones underneath (like shame, sadness, fear)?

What do you notice yourself doing—or avoiding—when you feel this way? (For example, do you shut down, procrastinate, overwork, eat, scroll, etc.?)

If nothing changed for a year or five years, what would you fear losing or missing out on—personally or professionally?

If this block was resolved or the goal was achieved, what would change in how you feel, act, and show up? What becomes possible that feels out of reach right now?

Even if it was fleeting or small, when have you noticed yourself coping differently? What was present in you or around you in those moments?

If you could replace that old voice with one clear, strong belief, what would you want it to say about you?”

If your inner critic had a personality or voice, what would it say—and what do you want your stronger self to say back?

By the end of this session, what would make you feel like a shift has truly happened?

Is there any additional information you would like to add that would be helpful to your session.

I consent to participate in the process of Hypnotherapy with Meghan Raza.I understand that hypnotherapy can involve the use of techniques such as progressive relaxation, meditation, guided imagery, and other helpful methods. As a part of hypnotherapy, clients are encouraged to recall events, circumstances, behaviours, thoughts, and feelings from situations in their life experiences. I understand that there is no implied or stated guarantee of success or effectiveness of hypnotherapy techniques.

I understand that clients vary in their response to the relaxation and hypnotic process, with some having powerful experiences and others experiencing relatively little. Additionally, I am aware that the experiences during hypnotherapy or reiki may be a combination of real and/or of active imagination. I also understand that certain memories or experiences may invoke emotional reactions. These emotionally charged experiences can be useful for facilitating insight and understanding. I accept that I am signing digitally a legal document and releasing Meghan Raza from liability and indemnity, and I agree not to take legal action against the same for healing services I have chosen freely.

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info@ascensionliving.ca

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certified hypnotherapist and neuro-performance coach working with clients across Canada online and in person. My work uses clinical hypnotherapy, NLP and neuropsychology-informed coaching to help women business owners and leaders work on pressure, performance and the patterns running underneath both. Clients also find this work under mindset coaching, subconscious work and stress and burnout support.

I am a member of the International Hypnosis Association and work to their Code of Ethics, which covers client confidentiality, practising within scope, and referral to licensed healthcare professionals where that is the right call.

I am not a medical doctor, psychologist, or regulated mental health professional. I do not diagnose, treat, or prescribe for medical or mental health conditions. If you have a medical or psychological concern, please consult a licensed healthcare provider.

© Copyright 2026. Ascension Living. All rights reserved. Ascension Living provides neuro-performance coaching and Psychological Health and Safety advisory services based in Prince Edward Island, Canada. 32 Captain James Crescent, Stratford, PEI C1B 4L6. For privacy inquiries, contact [email protected].