if you do not have experience please mark with NA
Please indicate if you have had or are currently undergoing any physical or psychological treatment
If yes please indicate what kind of surgery and how long ago?
Are you currently taking any medication? Have you been on medication recently? (it's important to inform even of anti-histamine use)
What is your normal blood pressure (high, low, normal)
do you currently use any substances like MDMA, cocaine , ... if yes please indicate which ones and how frequently.
indicate other kinds of addictions also please
are there any personal issues that you wish for us to be aware of? please indicate so here