additional questions for clients

Please fill in the fields of the questionnaire in a free format. This information will help in the work and save time on consultations. If you don't know what to answer, put a dash. Answers will be sent to my e-mail, everything is anonymous and confidential
(You won't receive any automatic e-mails or notifications)
Your name
Your e-mail
Marital status, children (if any), number of marriages
Tell me about your childhood: what was your family like, did you live with your parents? What emotions is your childhood connected with?
Do you have any brothers / sisters? What is the relationship with them?
Tell me about your mother. How do you remember her? How did she feel about you? Her occupation.
Tell me about your father. How do you remember him? How did he feel about you? His occupation.
What was the relationship between the parents?
What was the attitude towards the sexual side of life in the parental family (or from other close people)?
Did someone in the family have addictions (alcohol, drugs, religion, workaholism, obsession with ideas)?
Relations with peers (childhood, youth, now). Was there the bullying at school (and how strong)?
Relations with the members of the opposite sex (childhood, youth, now)
Do you have chronic illnesses (list, and indicate the age of onset of the disease)?
The process of your birth. How had been being the pregnancy of the mother? Were there any events in her life during pregnancy? How had been being the birth? Have there been birth injuries (asphyxia, cord entanglement, etc.)?
Describe the most significant events in your life that have shocked you.
Please describe the traumatic experience (abuse, betrayal, hospitalization, violence, etc.), at your discretion.
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