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DOCTOR FINDOM’S INTIAL ASSESSMENT

It’s imperative this questionnaire is completed with as much detail and accuracy as possible. Once you’ve submitted your answers and paid the initial fee, i aim to give you the therapy you require in a timely manner. I’ll administering the correct ‘dosage’ of my intoxicating medicine. Get your pants down for me.. Are you ready?

🔗 Complete this form & send $50 to secure your assessment and begin your tailored therapy today.

What do you wish to be called?

Age

Contact email (for checkups and aftercare)

Marital status

Brief history of therapy/counselling?

Current physical health

Sleeping habits

Are experiencing overwhelming sadness, grief or depression? (If yes, for approximately how long?)

Do you experience anxiety or panic attacks? (If yes, for approximately how long?)

Do you drink alcohol or consume other substances more than once a week?

Are you currently in a romantic relationship?

Yes

How long have you been in this relationship?

On a scale of 1-10 (1 being poor) how would you rate your relationship?

Have you experienced any life changing or stressful events recently?

Do you work?

Yes

What is your occupation?

Do you enjoy your job? Is it fulfilling?

What would you consider your personal strengths?

What are your weaknesses? (Be specific with kinks & fetishs)

What would you like to accomplish out of your time in therapy?

Submit your questionnaire and make payment. I expect your pants down ready for your in-depth, personal and exciting examination.

I look forward to helping you kick your addiction.