Zen Hypnosis 501(c)(3) Community Clinic & GIHA Residency

50-Hour Supervised Pro-Bono Practicum Log

Mandatory Clinical Rotation Requirement for CCHt Board Certification

50-HOUR
CLINICAL
ROTATION
Clinical Intern: Daniel Carl Geary Jr., CCHt, CRSS • Student ID: #001
Practicum Supervisor: Daniel Carl Geary Jr., CCHt, CRSS • Clinic Location: Attalla, AL Sanctuary / Telehealth
Date Client Initials Presenting Concern (ICD-10) Suggestibility Induction Protocol Hours Supervisor Initial
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________________________________Phys / EmoElman / Erickson1.0[   ]
________________________________Phys / EmoElman / Erickson1.0[   ]
________________________________Phys / EmoElman / Erickson1.0[   ]
________________________________Phys / EmoElman / Erickson1.0[   ]
________________________________Phys / EmoElman / Erickson1.0[   ]
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Daniel Carl Geary Jr., CCHt, CRSS
Clinical Hypnotherapist Intern
Daniel Carl Geary Jr., CCHt, CRSS
Master Practicum Supervisor • Zen Hypnosis 501(c)(3)