Mindsexology.com Pre-Session Questionnaire

Thank you for booking a session with Mindsexology.com. To help us understand your needs and provide the best support, please fill out this questionnaire. You can also discuss these questions privately during your free 15-minute consultation.

    Basic Information

    1.
    Full Name:
    2.
    Age:
    3.
    Gender:
    4.
    Preferred Language for the Session:

    Contact Information

    5.
    Email Address:
    6.
    Phone Number:
    7.
    WhatsApp:
    8.
    Telegram:
    9.
    WeChat:

    Session Goals

    10.
    Type of Session:
    11.
    Primary Reason for Seeking Therapy (select all that apply):

    Current Situation

    12.
    How long have you been experiencing this issue?
    13.
    Have you sought therapy or counseling before?
    14.
    If yes, what was your experience?
    15.
    How would you rate your current emotional well-being on a scale of 1-10?
    (1 = Very poor, 10 = Excellent)
    16.
    Are you currently facing any significant life changes?
    (e.g., divorce, career stress, relocation)

    Session Preferences

    17.
    Preferred Method of Communication:
    18.
    Availability for Sessions

    Relationship Dynamics (For Couples)

    19.
    What is your current relationship status?
    20.
    If you're in a relationship, how would you describe your current level of intimacy and communication?

    Goals and Expectations

    21.
    What do you hope to achieve from the session(s)?
    22.
    Are there specific topics or issues you'd like to address during the session?
    23.
    Have you set any personal or relationship goals that you want therapy to help you with?

    Additional Information

    24.
    Do you have any medical or mental health conditions we should be aware of?
    25.
    Do you have any preferences or concerns regarding the session?
    26.
    What concerns, if any, do you have about starting therapy?

    Thank you for completing this form! Your responses will help us tailor the session to your specific needs. If you have any additional questions or concerns, feel free to contact us at support@mindsexology.com or +66910076872.

    Email: