Do you suffer from a chronic illness?

Do you suffer from relapsing pain lately?

Do you have physical impairments?

Do you consume alcohol (glasses of wine 0.2l, bottle of beer 0.5l)?

If yes, how often?

When did you not consume alcohol for two days in a row?
In that time, did you have symptoms, e.g. tremor, attacks of sweating or insomnia/ sleeplessness?

Do you take medication?

Do you take other drugs (Cocaine, amphetamines, cannabis among others)?

Step 3/4

Private life

Which sports do you practice?

Do you care for friendships?

Do you take part in societal events?

On a scale from 0 to 10 (0 = no vitality at all, 10 = a lot of vitality), how would you describe your vitality/ enjoyment of life?

Step 3/4

Work life

Do you have difficulties to handle the required work?

Do you receive appreciation for your job?

Does your self-esteem/ self-confidence suffer?

Step 4/4

If we did not ask all relevant questions, you have the possibility to state outstanding issues, which we will include with pleasure to create a suitable therapy recommendation for you.

Personal data