Body Mind Healing | Formulier
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Telephone: Zip code+ Place: Birth date: Disease: Medications+ Dosage: Did you visit your physician for help?: If ‘no’’, why not? Drugs / Alcohol / Smoking How much and Cause: Why stopped: Marital Status. + Name + Birth date partner: How is / was the wedding experience?: Birth children, name + b. date, experience: No children, reason: Father / stepfather commits, b. date: Mother / Stepmother commits, b. date: Keyword family origin: Did you feel you home earlier with your parents? Divorce (s), experience (s): Occupation and / or activities: What do you think about your work?: How is the relationship with the employer and colleague (s)?: Do you have friend?s: Hobbies: Arched, if so cause: Abuse, physical (incest): Mental: Accident, what kind of ?: Are there events or situations in your life that impressed you very much? Do you know anything about your birth ?: Do you feel ‘’at home’’in this world? What do you think about yourself: How do you feel yourself mentally at this moment: What is your emotional condition at this moment? How is your physical condition? Complain: At what circumstances do you have these complaints?: Early Therapies: What is the reason of your decision to ask for help?: Why "Body Mind Healing"?: Questions/remarks: