Personal questionnaire Filling out the questionnaire will take approximately 5-10 minutes Profession Is your profession supportive and energizing? Current Life Situation Are you in a committed relationship or marriage? If yes, since when? Do you have children? If yes, how old are they? Natural birth or a cesarean section? Are you currently dealing with any mental health issues? YesNo Are you currently in psychotherapeutic treatment, or have you undergone psychotherapy in the past? What was helpful about that therapy? Have you attended any coachings, personal development workshops or retreats? Are you currently taking any medications or psychotropic drugs? YesNo Did you take any medications or psychotropic drugs in the past? YesNo Are you currently receiving medical or body-oriented therapeutic treatment? YesNo Are you currently pregnant? YesNo Mental Health Do you experience anxiety or panic attacks? YesNo Do you have difficulty concentrating? YesNo Medical Health Are you currently experiencing or have you regularly experienced any of the following symptoms?TinnitusDizzinessShortness of breathHeart palpitationsExcessive sweatingStomach painBack painMenstrual discomfortHeadachesMigraineNausea Do any of the following conditions apply to you?High blood pressureLow blood pressureCardiac arrhythmiaAngina pectorisAsthmaCOPDADHDADSDiabetesOsteoporosisArthrosisRheumatismKidney disease Are you currently experiencing pain or issues in any of the following areas?Cervical spine (neck)ShoulderElbowWristThoracic spine (upper back)Lumbar spine (lower back)HipKneeAnkle Have you had chest pain in recent months, either at rest or during physical activity?YesNo Have you experienced breathing difficulties, either at rest or during physical activity? YesNo Has a doctor ever prescribed you medication for high blood pressure, or for a heart or respiratory condition? YesNo Do you suffer from chronic pain? YesNo Have you ever had surgery, an accident, falls, fractures, or car accidents? YesNo Have you had any hospital stays? YesNo Do you have any allergies? YesNo Have you ever had suicidal thoughts? YesNo Have you ever attempted suicide? YesNo How did you find out about me? I understand that my information will be processed confidentially in accordance with the Privacy Policy. I confirm the general terms and conditions. Bitte lasse dieses Feld leer.
