DISCOVERY CALL APPLICATION

Discovery Call Application

First Name *

Last Name *

Email *

Phone Number

Street

House Number

Postal Code

City

Country

Which physical symptoms are you experiencing?

Fatigue

Insomnia

Headaches or muscle tension

Digestive issues

Weakened immune system

Which emotional symptoms are you experiencing?

Increased irritability

Anxiety

Depression

Lack of motivation

Emotional detachment

Which behavioral symptoms are you experiencing?

Decreased performance

Withdrawal and isolation

Reliance on coping mechanisms

Procrastination

Perfectionism

Which cognitive symptoms are you experiencing?

Concentration difficulties

Decreased creativity

Negative thinking patterns

Memory problems

Lack of mental clarity

Is there anything I should know about you in advance?

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