Yaou Yaou Wellness
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Iboga Bwiti Retreats Kambo Treatments Cacao and Hibiscus Healing Circles 1:1 Afro-Indigenous Coaching and Consulting Group Afro-Indigenous Coaching and Consulting Select All
Have you had a liver panel recently or in the past? If yes, when and what were the results? Have you had an EKG (electrocardiogram) test done? If yes, when and what were the results?
Are you pregnant? Have you ever suffered from a heart condition? Have you ever suffered from a liver condition? Have you been hospitalized in the last 20 years? Have you ever been hospitalized for a psychiatric illness? Is there anyone in your family with a history of psychiatric disorders? Are you currently receiving therapy or attending any kind of support group? N/A Select All
Medical Diagnosis – Please list all medical diagnosis, past and current, with dates. Medications and Supplements – Please list all medications, prescribed or otherwise, and supplements. Please include dosage and frequency. Do you currently experience addiction to any drugs, or have you in the past? If so, please describe what & frequency/dosage. Are you addicted to alcohol, or have you been in the past? if so, please describe.
Cannabis Internet / Social Media Cigarettes Exercise Coffee Shopping TV Food Sex Pornography Prescription Medication Drugs None of the above Select All
Describe your relationship to food. Please be specific. *
Dislike your body shape or size? Fear of certain foods or preoccupation with food causing illness? Overeating then purging by vomiting? Eating or overeating when emotional? Stopped eating or deprived yourself of food? Ever been diagnosed or treated for an eating disorder? None of the above Select All
How well do you sleep? Do you feel rested upon rising? Please be specific. * Where are your parents from? What is your relationship with them? Please be specific. Whats your current relationship with your siblings? Please be specific. * Is there anything else about your physical or emotional state we should know about? (“N/A” if does not apply) Marital/relationship status. Please be specific. * Do you have children? Do they live with you? Please be specific. * Whats your current relationship with friends? Please be specific. * What are current stressors in your life? * What do you do for fun? *
Combat/war Being held hostage or imprisoned Terrorism or hate crime Natural or man-made disaster Accidents Diagnosis of life threatening illness Sexual abuse Physical abuse Torture None of the above Select All
Please elaborate on any above checked items.
Deaths Pregnancy Relationships Jobs Culture None of the above Select All
Please elaborate on any above checked items
Cutting Inserting sharp objects into the skin Biting Swallowing sharp objects or hamful substances Scratching Scraping Picking Pulling out hair None of the above Select All
Please elaborate on any above checked items. Have you taken any indigenous plant or animal medicines before? If so, please list them below. (“N/A” if does not apply) What is your current diet? Do you have any dietary restrictions or food you avoid? (i.e. lactose intolerance, gluten sensitivity) Have you ever had thoughts of hurting yourself or another? When was the last time? Do you ever have hallucinations? Paranoid thoughts? Hear voices? Memory loss? Do you experience fears or phobias that interfere with day to day living? If so, what? Do you experience any sexual disfunction? i.e. lack of ability or interest in sex? * What are the reasons you’re seeking natural medicine at this time in your life? * Please list the name and number of at least one (1) emergency contact: *
Yes
Les amateurs exigeants trouvent en spinsy 6 une plateforme qui ne fait pas de compromis sur la qualité. L’offre de machines à sous est particulièrement étendu et couvre des thématiques très variées. Les conditions d’utilisation sont rédigées dans un français clair, sans jargon inutile.
