Personal questionnaire Filling out the questionnaire will take approximately 10–20 minutes Profession Is your profession supportive and energizing? Current Life Situation Are you currently pregnant? JaNein 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? Relationship & Family Are you in a committed relationship or marriage? If yes, since when? Have you given birth to children? If yes, how old are they? Do you have siblings? If yes, please state their gender and age Is there anyone in your family who is affected by mental health challenges? JaNein Were there any significant experiences, losses, or traumas in your childhood—such as death, divorce, or other impactful events? Can you share something about your birth? Mental Health Do you experience anxiety or panic attacks? JaNein Are you currently dealing with any mental health issues? JaNein Have you ever had suicidal thoughts or attempted suicide? JaNein Medical Health Are you currently receiving medical or body-oriented therapeutic treatment? YesNo Are you currently taking birth control? JaNein Are you currently taking any medications or psychotropic drugs? JaNein Have you taken psychotropic medication in the past? JaNein Have you ever used psychedelic medicine? JaNein 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?[checkbox Following_Conditions use_label_element "High blood pressure" "Low blood pressure" "Cardiac arrhythmia" Angina pectoris" "Asthma" "COPD" "ADHS" "ADS" "Diabetes" "Osteoporosis" "Arthrosis" "Rheumatism" "Kidney 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?JaNein Have you experienced breathing difficulties, either at rest or during physical activity? JaNein Has a doctor ever prescribed you medication for high blood pressure, or for a heart or respiratory condition? JaNein Do you suffer from chronic pain? JaNein Have you ever had surgery, an accident, falls, fractures, or car accidents? JaNein Have you had any hospital stays? JaNein Do you have any allergies? JaNein Lifestyle Habits Do you consume any stimulants or substances (e.g., marijuana, alcohol, or others)? JaNein Do you have any experience with other drugs? JaNein Do you smoke? JaNein What kind of diet do you follow? (Plant-based/Vegan, Vegetarian, Mixed diet)? How would you describe your sleep patterns? (Falling asleep, staying asleep, waking up) Do you take any dietary supplements? If yes, which ones? Do you find it difficult to include regular physical activity in your daily routine? JaNein What types of physical activities or sports do you currently practice, and how many hours per week? What gives you strength or nourishes you? What do you enjoy doing in your free time? How did you find out about me? Ich verstehe, dass meine Angaben gemäß der Datenschutzerklärung vertrauensvoll verarbeitet werden. Ich bestätige die allgemeinen Geschäftsbedingungen. Bitte lasse dieses Feld leer.
