Medical Astrology Questionnaire

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Hello! And thank you for participating. Please fill out whatever is applicable to you. If there is additional information that is relevant please also include that. The more information the better so that I have a fuller understanding of your story.

If you feel that a chat over Zoom could be helpful for me to have greater understanding of your circumstances, I am happy to arrange for that as well. Additionally, I may reach out with further questions.

You can always reach me at : lisa@thedynamicselfastrology.com

Medical astrology in general and mental health specifically is still being understood within the astrological community and your contribution is helping us to continue to learn and be better astrologers. Thank you so much!

Name (first and last) - you will be kept anonymous *

Email *

Birth Data : Date, Time (as accurate as possible), and Location *

What Mental Health Condition(s) have you been diagnosed with? *

When were you diagnosed with the condition(s) (date as specific & accurate as possible)? Please explain. *

Were there impactful events that lead up to the diagnosis? What were the dates (as specific & accurate as possible) for these events? Please be as detailed as possible. *

Is this an inherited condition? If so, please explain (ex. from mother or father's side)? *

Is this a condition that was rooted in either the early childhood environment / patterning / survival or other impactful events? Please explain. If there are any relevant dates please include (month and year or more detailed if you remember). *

Please briefly describe your early childhood experience. *

Is this a condition that is solely chemical imbalance (not environmentally formed)? Please explain. *

If you have a chemical imbalance that is the root cause of your mental health condition, how did your early childhood environment / early adult environment interact with your journey? *

If applicable, please briefly describe any impactful events that have contributed to your mental health condition. *

Are there areas of your life that you have had to sacrifice or modify because of your mental health condition (ex. work, relationship, family, etc)? Please explain. *

Do you consider yourself a creative person? If so, what creative medium(s) do you work in? *

Do you suffer from digestive complications as well? Or other notable health conditions (such as headaches or anything else)? Please explain. *

If applicable, is there a connection between your mental health condition and the other health issues that you experience? *

What have you done to navigate your mental health condition? Are you on medication? What tools to you utilize (therapy, exercise, diet, etc)? Please explain. *

Do you feel as though you have your mental health condition under control at this time? Have you been able to create a stable life in the midst of your challenges? *

What is your relationship to stability like? Are you able to maintain and enjoy it? Or is it more complicated? Please explain. *

Have you gained insight into life via your mental health journey that you would like to share? *

Is there anything else that I should I know about your experience with mental health? *

Please verify that you understand that I will be using this information anonymously for an astrological course and potentially for future astrological presentations.

** Write your name and the date below **

Please verify that I can use your anonymous information for research and presentations.

** Write your name and date below **

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