Mini questionnaire
Email address *
What is your main concern which makes you look up a psychologist/psychotherapist/coach?
Your answer
How long have you this problem/these issues?
Have you worked with a psychotherapist/psychologist/psychiatrist before?
If you have experience with psychotherapy: Do you remember what kind of therapy it was?
How satisfied are you with the psycho-help you received?
not so much - was not helpful
very much - was very helpful
What do you hope for you will get/learn through the exchange and work with a "psycho-professional"?
Your answer
When is your birthday?
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DD
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YYYY
Please tell me your full name and address. I need these details for the invoice production afterwards.
Your answer
Do you want to receive an invoice? I would send it to the mail address stated above.
...and, in order to get in contact with you via phone (15 minutes getting to know each other): I need your phone number. You can write it down here or you send me a WhatsApp or Signal message at 0176 434 28766 (then I'll have your number and can call you).
Your answer
Thank you very much for your time and feedback/info provided! If you have questions/comments -- you can leave a note here:
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