{"id":2140,"date":"2024-10-23T17:46:33","date_gmt":"2024-10-23T16:46:33","guid":{"rendered":"https:\/\/mitellus.fr\/?p=2140"},"modified":"2025-06-12T23:42:12","modified_gmt":"2025-06-12T22:42:12","slug":"hypno-intake-form","status":"publish","type":"post","link":"https:\/\/mitellus.fr\/?p=2140","title":{"rendered":"How can I help?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">All info provided are used to enhance the way I will assist you (in French or in English).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is okay if you leave some fields empty, we can talk about it if needed later. <\/p>\n\n\n    <div id=\"mawHypnoForm\">\n        <h2>Hypnotherapy Intake Form<\/h2>\n        <form id=\"mawHypno\" method=\"post\" action=\"https:\/\/mitellus.fr\/wp-admin\/admin-ajax.php\">\n            <input type=\"hidden\" name=\"action\" value=\"maw_hypno_ind_submit\">\n            <input type=\"hidden\" name=\"redirect_url\" value=\"https:\/\/mitellus.fr\/?p=2140\">\n            <input type=\"hidden\" name=\"Timestamp\" value=\"2026-06-04 21:59:22\">\n            <input type=\"hidden\" name=\"UniqueID\" id=\"unique_id\" value=\"XnhH34\">\n            <input type=\"hidden\" name=\"IPAddress\" value=\"216.73.216.230\">\n            <input type=\"hidden\" name=\"UserAgent\" value=\"Mozilla\/5.0 AppleWebKit\/537.36 (KHTML, like Gecko; compatible; ClaudeBot\/1.0; +claudebot@anthropic.com)\">\n            <input type=\"hidden\" name=\"DeviceType\" value=\"Desktop\">\n\n            <!-- Personal Information -->\n            <div class=\"form-section\">\n                <h3>Personal Information<\/h3>\n                <label for=\"name\">Name *:<\/label>\n                <input type=\"text\" id=\"name\" name=\"Name\" required>\n                <span id=\"name-error\" class=\"error-message\">Please enter your name.<\/span><br><br>\n\n                <label for=\"email\">Email *:<\/label>\n                <input type=\"email\" id=\"email\" name=\"Email\" required>\n                <span id=\"email-error\" class=\"error-message\">Please enter a valid email.<\/span><br><br>\n\n                <label for=\"primary_goal\">Primary Goal *:<\/label>\n                <input type=\"text\" id=\"primary_goal\" name=\"PrimaryGoal\" required>\n                <span id=\"goal-error\" class=\"error-message\">Please enter your primary goal.<\/span><br><br>\n\n                <label for=\"severity\">Severity (1-10) *:<\/label>\n                <div class=\"button-group\" id=\"severity-buttons\">\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"1\">1<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"2\">2<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"3\">3<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"4\">4<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"5\">5<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"6\">6<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"7\">7<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"8\">8<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"9\">9<\/button>\n                                            <button type=\"button\" class=\"severity-button\" data-value=\"10\">10<\/button>\n                                    <\/div>\n                <input type=\"hidden\" id=\"severity\" name=\"Severity\" required>\n                <span id=\"severity-error\" class=\"error-message\">Please select severity.<\/span><br><br>\n\n                <label for=\"duration\">Since when do you have this concern?<\/label>\n                <input type=\"text\" id=\"duration\" name=\"Duration\"><br><br>\n\n                <label for=\"previous_attempts\">What have you already tried?<\/label>\n                <textarea id=\"previous_attempts\" name=\"PreviousAttempts\"><\/textarea><br><br>\n\n                <label for=\"medications\">Current Medications *:<\/label>\n                <textarea id=\"medications\" name=\"CurrentMedications\" required><\/textarea>\n                <span id=\"medications-error\" class=\"error-message\">Please list medications or 'None'.<\/span><br><br>\n            <\/div>\n\n            <!-- Medical Contacts -->\n            <div class=\"form-section collapsible\">\n                <h3 class=\"toggle-section\">Medical Contacts <span class=\"toggle-icon\">+<\/span><\/h3>\n                <div class=\"section-content\" style=\"display: none;\">\n                    <label for=\"doctor_contact\">Doctor Contact:<\/label>\n                    <input type=\"text\" id=\"doctor_contact\" name=\"DoctorContact\"><br><br>\n                    <label for=\"medical_conditions\">Medical Conditions:<\/label>\n                    <textarea id=\"medical_conditions\" name=\"MedicalConditions\"><\/textarea><br><br>\n                    <label for=\"mental_health_history\">Mental Health History:<\/label>\n                    <textarea id=\"mental_health_history\" name=\"MentalHealthHistory\"><\/textarea><br><br>\n                    <label for=\"hypnosis_experience\">Hypnosis Experience:<\/label>\n                    <textarea id=\"hypnosis_experience\" name=\"HypnosisExperience\"><\/textarea><br><br>\n                <\/div>\n            <\/div>\n\n            <!-- L\u00fcscher Color Test 1 -->\n            <div class=\"form-section\">\n                <h3>L\u00fcscher Color Test 1<\/h3>\n                <p>Select colors in order of preference:<\/p>\n                <div id=\"color_test1-colors\"><\/div>\n                <span id=\"color_test1-error\" class=\"error-message\">Please select at least 7 colors.<\/span>\n                <input type=\"hidden\" id=\"color_test1\" name=\"color_test1\">\n            <\/div>\n\n            <!-- Additional Personal Info -->\n            <div class=\"form-section collapsible\">\n                <h3 class=\"toggle-section\">Additional Personal Information <span class=\"toggle-icon\">+<\/span><\/h3>\n                <div class=\"section-content\" style=\"display: none;\">\n                    <label for=\"phone\">Phone:<\/label>\n                    <input type=\"text\" id=\"phone\" name=\"Phone\"><br><br>\n                    <label for=\"date_of_birth\">Date of Birth:<\/label>\n                    <input type=\"date\" id=\"date_of_birth\" name=\"DateOfBirth\"><br><br>\n                    <label for=\"emergency_contact\">Emergency Contact:<\/label>\n                    <input type=\"text\" id=\"emergency_contact\" name=\"EmergencyContact\"><br><br>\n                    <label for=\"address\">Address:<\/label>\n                    <textarea id=\"address\" name=\"Address\"><\/textarea><br><br>\n                    <label for=\"occupation\">Occupation:<\/label>\n                    <input type=\"text\" id=\"occupation\" name=\"Occupation\"><br><br>\n                    <label for=\"hobbies\">Hobbies:<\/label>\n                    <textarea id=\"hobbies\" name=\"Hobbies\"><\/textarea><br><br>\n                    <label for=\"relax_place\">Relaxation Place:<\/label>\n                    <input type=\"text\" id=\"relax_place\" name=\"RelaxPlace\"><br><br>\n                    <label for=\"spiritual_beliefs\">Spiritual Beliefs:<\/label>\n                    <textarea id=\"spiritual_beliefs\" name=\"SpiritualBeliefs\"><\/textarea><br><br>\n                    <label for=\"marital_status\">Marital Status:<\/label>\n                    <input type=\"text\" id=\"marital_status\" name=\"MaritalStatus\"><br><br>\n                    <label for=\"sexual_preferences\">Sexual Preferences:<\/label>\n                    <div class=\"button-group\" id=\"sexual_preferences-buttons\">\n                        <button type=\"button\" class=\"sexual-preference-button\" data-value=\"1\" data-label=\"Opposite Gender Only\">Opposite Gender Only<\/button>\n                        <button type=\"button\" class=\"sexual-preference-button\" data-value=\"2\" data-label=\"Prefer Opposite Gender\">Prefer Opposite Gender<\/button>\n                        <button type=\"button\" class=\"sexual-preference-button\" data-value=\"3\" data-label=\"Both Genders\">Both Genders<\/button>\n                        <button type=\"button\" class=\"sexual-preference-button\" data-value=\"4\" data-label=\"Prefer Same Gender\">Prefer Same Gender<\/button>\n                        <button type=\"button\" class=\"sexual-preference-button\" data-value=\"5\" data-label=\"Same Gender Only\">Same Gender Only<\/button>\n                    <\/div>\n                    <input type=\"hidden\" id=\"sexual_preferences\" name=\"SexualPreferences\"><br><br>\n                    <label for=\"children\">Children:<\/label>\n                    <input type=\"text\" id=\"children\" name=\"Children\"><br><br>\n                <\/div>\n            <\/div>\n\n            <!-- Mental Health History -->\n            <div class=\"form-section collapsible\">\n                <h3 class=\"toggle-section\">Mental Health History <span class=\"toggle-icon\">+<\/span><\/h3>\n                <div class=\"section-content\" style=\"display: none;\">\n                                            <label for=\"feeling_sad\">Feeling Sad:<\/label>\n                        <div class=\"button-group\" id=\"feeling_sad-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"feeling_sad\" name=\"FeelingSad\">\n                        <span id=\"feeling_sad-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"decision_difficulty\">Decision Difficulty:<\/label>\n                        <div class=\"button-group\" id=\"decision_difficulty-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"decision_difficulty\" name=\"DecisionDifficulty\">\n                        <span id=\"decision_difficulty-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"guilt_shame\">Guilt Shame:<\/label>\n                        <div class=\"button-group\" id=\"guilt_shame-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"guilt_shame\" name=\"GuiltShame\">\n                        <span id=\"guilt_shame-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"feeling_tired\">Feeling Tired:<\/label>\n                        <div class=\"button-group\" id=\"feeling_tired-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"feeling_tired\" name=\"FeelingTired\">\n                        <span id=\"feeling_tired-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"restlessness\">Restlessness:<\/label>\n                        <div class=\"button-group\" id=\"restlessness-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"restlessness\" name=\"Restlessness\">\n                        <span id=\"restlessness-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"loss_interest_social\">Loss Interest Social:<\/label>\n                        <div class=\"button-group\" id=\"loss_interest_social-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"loss_interest_social\" name=\"LossInterestSocial\">\n                        <span id=\"loss_interest_social-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"loss_interest_work\">Loss Interest Work:<\/label>\n                        <div class=\"button-group\" id=\"loss_interest_work-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"loss_interest_work\" name=\"LossInterestWork\">\n                        <span id=\"loss_interest_work-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"appetite_change\">Appetite Change:<\/label>\n                        <div class=\"button-group\" id=\"appetite_change-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"appetite_change\" name=\"AppetiteChange\">\n                        <span id=\"appetite_change-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"suicidal_thoughts\">Suicidal Thoughts:<\/label>\n                        <div class=\"button-group\" id=\"suicidal_thoughts-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"suicidal_thoughts\" name=\"SuicidalThoughts\">\n                        <span id=\"suicidal_thoughts-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"panic_anxiety\">Panic Anxiety:<\/label>\n                        <div class=\"button-group\" id=\"panic_anxiety-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"panic_anxiety\" name=\"PanicAnxiety\">\n                        <span id=\"panic_anxiety-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                                        <label for=\"ocd_compulsions\">Ocd Compulsions:<\/label>\n                        <div class=\"button-group\" id=\"ocd_compulsions-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"ocd_compulsions\" name=\"OCDCompulsions\">\n                        <span id=\"ocd_compulsions-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                    <div id=\"ocd_compulsions_details_wrapper\" style=\"display: none;\">\n                                <label for=\"ocd_compulsions_details\">Ocd Compulsions Details:<\/label>\n                                <textarea id=\"ocd_compulsions_details\" name=\"OCDCompulsionsDetails\"><\/textarea><br><br>\n                            <\/div>\n                                                                        <label for=\"rituals\">Rituals:<\/label>\n                        <div class=\"button-group\" id=\"rituals-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"rituals\" name=\"Rituals\">\n                        <span id=\"rituals-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                    <div id=\"rituals_details_wrapper\" style=\"display: none;\">\n                                <label for=\"rituals_details\">Rituals Details:<\/label>\n                                <textarea id=\"rituals_details\" name=\"RitualsDetails\"><\/textarea><br><br>\n                            <\/div>\n                                                                        <label for=\"recurring_dreams\">Recurring Dreams:<\/label>\n                        <div class=\"button-group\" id=\"recurring_dreams-buttons\">\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"0\" data-label=\"Not at All\">Not at All<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"1\" data-label=\"Somewhat\">Somewhat<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"2\" data-label=\"Moderate\">Moderate<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"3\" data-label=\"A Lot\">A Lot<\/button>\n                                                            <button type=\"button\" class=\"mental-health-button\" data-value=\"4\" data-label=\"Extremely\">Extremely<\/button>\n                                                    <\/div>\n                        <input type=\"hidden\" id=\"recurring_dreams\" name=\"RecurringDreams\">\n                        <span id=\"recurring_dreams-error\" class=\"error-message\">Please select an option.<\/span><br><br>\n                                                    <div id=\"recurring_dreams_details_wrapper\" style=\"display: none;\">\n                                <label for=\"recurring_dreams_details\">Recurring Dreams Details:<\/label>\n                                <textarea id=\"recurring_dreams_details\" name=\"RecurringDreamsDetails\"><\/textarea><br><br>\n                            <\/div>\n                                                                <\/div>\n            <\/div>\n\n            <!-- Phobias -->\n            <div class=\"form-section collapsible\">\n                <h3 class=\"toggle-section\">Phobias <span class=\"toggle-icon\">+<\/span><\/h3>\n                <div class=\"section-content\" style=\"display: none;\">\n                                            <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_spiders\" data-field=\"PhobiaSpiders\" data-details=\"phobia_spiders_details\">Spiders<\/button>\n                            <input type=\"hidden\" name=\"PhobiaSpiders\" id=\"phobia_spiders_value\">\n                        <\/div>\n                        <div id=\"phobia_spiders_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_spiders_details\">Spiders Details:<\/label>\n                            <textarea id=\"phobia_spiders_details\" name=\"PhobiaSpidersDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_snakes\" data-field=\"PhobiaSnakes\" data-details=\"phobia_snakes_details\">Snakes<\/button>\n                            <input type=\"hidden\" name=\"PhobiaSnakes\" id=\"phobia_snakes_value\">\n                        <\/div>\n                        <div id=\"phobia_snakes_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_snakes_details\">Snakes Details:<\/label>\n                            <textarea id=\"phobia_snakes_details\" name=\"PhobiaSnakesDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_flying\" data-field=\"PhobiaFlying\" data-details=\"phobia_flying_details\">Flying<\/button>\n                            <input type=\"hidden\" name=\"PhobiaFlying\" id=\"phobia_flying_value\">\n                        <\/div>\n                        <div id=\"phobia_flying_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_flying_details\">Flying Details:<\/label>\n                            <textarea id=\"phobia_flying_details\" name=\"PhobiaFlyingDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_needles\" data-field=\"PhobiaNeedles\" data-details=\"phobia_needles_details\">Needles<\/button>\n                            <input type=\"hidden\" name=\"PhobiaNeedles\" id=\"phobia_needles_value\">\n                        <\/div>\n                        <div id=\"phobia_needles_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_needles_details\">Needles Details:<\/label>\n                            <textarea id=\"phobia_needles_details\" name=\"PhobiaNeedlesDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_thunder\" data-field=\"PhobiaThunder\" data-details=\"phobia_thunder_details\">Thunder<\/button>\n                            <input type=\"hidden\" name=\"PhobiaThunder\" id=\"phobia_thunder_value\">\n                        <\/div>\n                        <div id=\"phobia_thunder_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_thunder_details\">Thunder Details:<\/label>\n                            <textarea id=\"phobia_thunder_details\" name=\"PhobiaThunderDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_enclosed\" data-field=\"PhobiaEnclosed\" data-details=\"phobia_enclosed_details\">Enclosed<\/button>\n                            <input type=\"hidden\" name=\"PhobiaEnclosed\" id=\"phobia_enclosed_value\">\n                        <\/div>\n                        <div id=\"phobia_enclosed_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_enclosed_details\">Enclosed Details:<\/label>\n                            <textarea id=\"phobia_enclosed_details\" name=\"PhobiaEnclosedDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_germs\" data-field=\"PhobiaGerms\" data-details=\"phobia_germs_details\">Germs<\/button>\n                            <input type=\"hidden\" name=\"PhobiaGerms\" id=\"phobia_germs_value\">\n                        <\/div>\n                        <div id=\"phobia_germs_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_germs_details\">Germs Details:<\/label>\n                            <textarea id=\"phobia_germs_details\" name=\"PhobiaGermsDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_dogs\" data-field=\"PhobiaDogs\" data-details=\"phobia_dogs_details\">Dogs<\/button>\n                            <input type=\"hidden\" name=\"PhobiaDogs\" id=\"phobia_dogs_value\">\n                        <\/div>\n                        <div id=\"phobia_dogs_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_dogs_details\">Dogs Details:<\/label>\n                            <textarea id=\"phobia_dogs_details\" name=\"PhobiaDogsDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_cats\" data-field=\"PhobiaCats\" data-details=\"phobia_cats_details\">Cats<\/button>\n                            <input type=\"hidden\" name=\"PhobiaCats\" id=\"phobia_cats_value\">\n                        <\/div>\n                        <div id=\"phobia_cats_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_cats_details\">Cats Details:<\/label>\n                            <textarea id=\"phobia_cats_details\" name=\"PhobiaCatsDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_clowns\" data-field=\"PhobiaClowns\" data-details=\"phobia_clowns_details\">Clowns<\/button>\n                            <input type=\"hidden\" name=\"PhobiaClowns\" id=\"phobia_clowns_value\">\n                        <\/div>\n                        <div id=\"phobia_clowns_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_clowns_details\">Clowns Details:<\/label>\n                            <textarea id=\"phobia_clowns_details\" name=\"PhobiaClownsDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_crowds\" data-field=\"PhobiaCrowds\" data-details=\"phobia_crowds_details\">Crowds<\/button>\n                            <input type=\"hidden\" name=\"PhobiaCrowds\" id=\"phobia_crowds_value\">\n                        <\/div>\n                        <div id=\"phobia_crowds_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_crowds_details\">Crowds Details:<\/label>\n                            <textarea id=\"phobia_crowds_details\" name=\"PhobiaCrowdsDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_blushing\" data-field=\"PhobiaBlushing\" data-details=\"phobia_blushing_details\">Blushing<\/button>\n                            <input type=\"hidden\" name=\"PhobiaBlushing\" id=\"phobia_blushing_value\">\n                        <\/div>\n                        <div id=\"phobia_blushing_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_blushing_details\">Blushing Details:<\/label>\n                            <textarea id=\"phobia_blushing_details\" name=\"PhobiaBlushingDetails\"><\/textarea><br><br>\n                        <\/div>\n                                                <div>\n                            <button type=\"button\" class=\"phobia-button\" id=\"phobia_other\" data-field=\"PhobiaOther\" data-details=\"phobia_other_details\">Other<\/button>\n                            <input type=\"hidden\" name=\"PhobiaOther\" id=\"phobia_other_value\">\n                        <\/div>\n                        <div id=\"phobia_other_details_wrapper\" style=\"display: none;\">\n                            <label for=\"phobia_other_details\">Other Details:<\/label>\n                            <textarea id=\"phobia_other_details\" name=\"PhobiaOtherDetails\"><\/textarea><br><br>\n                        <\/div>\n                                        <\/div>\n            <\/div>\n\n            <!-- L\u00fcscher Color Test 2 -->\n            <div class=\"form-section\">\n                <h3>L\u00fcscher Color Test 2<\/h3>\n                <p>Select colors in order of preference:<\/p>\n                <div id=\"color_test2-colors\"><\/div>\n                <span id=\"color_test2-error\" class=\"error-message\">Please select at least 7 colors.<\/span>\n                <input type=\"hidden\" id=\"color_test2\" name=\"color_test2\">\n            <\/div>\n\n            <!-- Session Preferences -->\n            <div class=\"form-section\">\n                <label for=\"session_format\">Session Format *:<\/label>\n                <select id=\"session_format\" name=\"SessionFormat\" required>\n                    <option value=\"\">Select...<\/option>\n                    <option value=\"In Person\">In Person<\/option>\n                    <option value=\"Online\">Online<\/option>\n                    <option value=\"Hybrid\">Hybrid<\/option>\n                <\/select>\n                <span id=\"format-error\" class=\"error-message\">Please select a session format.<\/span><br><br>\n                <label for=\"preferred_times\">Preferred Times:<\/label>\n                <textarea id=\"preferred_times\" name=\"PreferredTimes\"><\/textarea><br><br>\n            <\/div>\n\n            <!-- Additional Info -->\n            <div class=\"form-section\">\n                <label for=\"additional_info\">Additional Information:<\/label>\n                <textarea id=\"additional_info\" name=\"AdditionalInfo\"><\/textarea><br><br>\n            <\/div>\n\n            <!-- Consents -->\n            <div class=\"form-section\">\n                <div>\n                    <input type=\"checkbox\" id=\"gdpr_consent\" name=\"gdpr_consent\" value=\"Yes\" required>\n                    <label for=\"gdpr_consent\">I consent to GDPR terms *<\/label>\n                    <span id=\"gdpr-error\" class=\"error-message\">GDPR consent is required.<\/span>\n                <\/div>\n                <div>\n                    <input type=\"checkbox\" id=\"health_consent\" name=\"health_consent\" value=\"Yes\" required>\n                    <label for=\"health_consent\">I consent to health data processing *<\/label>\n                    <span id=\"health-error\" class=\"error-message\">Health consent is required.<\/span>\n                <\/div>\n                <div>\n                    <input type=\"checkbox\" id=\"trance_consent\" name=\"trance_consent\" value=\"Yes\" required>\n                    <label for=\"trance_consent\">I consent to hypnosis sessions *<\/label>\n                    <span id=\"trance-error\" class=\"error-message\">Trance consent is required.<\/span>\n                <\/div>\n            <\/div>\n\n            <!-- Honeypot -->\n            <div style=\"display: none;\">\n                <label for=\"website\">Leave this blank:<\/label>\n                <input type=\"text\" id=\"website\" name=\"website\">\n            <\/div>\n\n            <button type=\"submit\" class=\"submit-button\">Submit<\/button>\n            <div id=\"mawHypnoLoading\" style=\"display: none; text-align: center; margin-top: 10px;\">\n                <span>Submitting...<\/span>\n            <\/div>\n        <\/form>\n    <\/div>\n    \n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>All info provided are used to enhance the way I will assist you (in French or in English). It is okay if you leave some fields empty, we can talk about it if needed later.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[28,1,29],"tags":[40],"class_list":["post-2140","post","type-post","status-publish","format-standard","hentry","category-courses","category-experience","category-hypnotherapy","tag-hypnosis"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/mitellus.fr\/index.php?rest_route=\/wp\/v2\/posts\/2140","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mitellus.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mitellus.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mitellus.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mitellus.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2140"}],"version-history":[{"count":18,"href":"https:\/\/mitellus.fr\/index.php?rest_route=\/wp\/v2\/posts\/2140\/revisions"}],"predecessor-version":[{"id":4944,"href":"https:\/\/mitellus.fr\/index.php?rest_route=\/wp\/v2\/posts\/2140\/revisions\/4944"}],"wp:attachment":[{"href":"https:\/\/mitellus.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2140"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mitellus.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2140"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mitellus.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2140"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}