Therapy Application Form

Pre-Session Brief Information Form

The following questions have been prepared to help us begin the therapy process more consciously and securely.
Responses are confidential and are used solely to support the therapy process.

1. Your Name – Surname

(…)

2. Your Age

(…)

3. Your Date of Birth

(Day / Month / Year)

4. Do You Know Your Time of Birth?

☐ Yes (Time: ……)
☐ I know it approximately
☐ No / I am not sure

(Information about the time of birth is used for temperament studies. The process can proceed even if it is unknown.)

5. What is the reason for starting this process?

(You can briefly write down the main reason that brought you here in your own words.)

6. Which area in your life is currently the most challenging for you?

☐ Physical difficulties
☐ Emotional burden / stress
☐ Relationships
☐ Life rhythm / burnout
☐ Lack of direction / indecision
☐ A general need for balance

7. How long has this difficulty been going on?

☐ For a short time
☐ For some time
☐ For a long time
☐ No clear beginning

8. Have you received support for similar issues before?

☐ No
☐ Yes (if you would like to specify briefly: ……)

9. Are you currently working with a doctor, psychologist, or another health professional?

☐ No
☐ Yes

(Specifying if you are helps us conduct the process more ethically and safely.)

10. What are your expectations from this process?

☐ To know myself better
☐ To gain balance and awareness
☐ To understand the language of my body / emotions
☐ To regulate my life rhythm
☐ Not clear yet