Compassionate Inquiry Demo Session Registration

Registration Form

Full Name *

Email *

Date of Birth (MM/DD/YY)

Profession

City

Country

Are you interested in participating as a “client” for the CI Session? We will choose people from those who answer ‘yes’ to this question.

Yes

If you have said “yes” above, what is the issue or situation you would like to discuss, explore or resolve?

To be filled if you are signing up as a client - Are you currently seeing a therapist, who can follow up with you after the session if required?

Yes

To be filled if you are signing up as a client - Are you on any prescribed medication?

Yes

To be filled if you are signing up as a client - Do you have a history of diagnosed mental illness? If yes, and if you are willing to share, what was the diagnosis?

To be filled if you are signing up as a client - Do you currently experience suicidal thoughts?

Yes

How did you learn about Compassionate Inquiry?

Form submission[]

Please note: The demo session will be recorded for use in training and for marketing purposes. Opting to be a demo client gives Compassionate Inquiry Inc. permission to share the recording on social media.

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