Walk-In questionnaire


Have you experienced or are experiencing any of the following:
A change (or changes) in your personality? A change in personal preferences such as foods, clothing, colours and lifestyle?
Depression, feelings of inexplicable grief or of wanting to die? Schizophrenia, feeling like you are going crazy or feeling like you are many different people at once?
Allergies and autoimmune diseases? The feeling like you are here to do something very special but can’t remember what it is?
Body pains, joint pains, arthritis symptoms? Exhaustion and fatigue that are out of proportion to your level of exertion?
Sudden changes in relationships with friends, family, partners and pets? Hypersensitivity to others feelings and thoughts?
Feeling really sick, crazy or unwell after spending much time with your family? Feeling really spaced out and ungrounded?
Being so out of the body that you crash into walls? Memory loss of big chunks of your life or of what you said yesterday?
Wanting to wear hats all the time? A sense of completion with life, saying “goodbye” to friends and family even though you do/did not know why?
Severe illness, accident, coma, concussion or emotional shock? Epileptic-like seizures?
A feeling like everyone is asleep around you, why are they doing all this weird stuff, can’t they see what’s really going on? A feeling of newness and wonder about the world?
Unable to express what you really feel and think in the English language? Feeling like “who are these strangers who think they are my family”?
Wondering “why don’t they tell the truth”? A strong urge to tell the truth no matter what?
Appearing to be ruthless/rude/cold to other people? Clumsiness or poor coordination
Feeling like an alien on this planet Wondering “who are all the aliens here and what are they doing?”
A complete lack of emotional attachments to parts of your past, as if it was a movie? An inability to find the food you really want to eat?
A desire not to speak coming from the sense that you can’t convey what you really want to say? A feeling of needing to change your name “my name is not my name”?
Hypersensitivity to electromagnetic frequencies, computers, TVs, overhead power lines, mobile phones & masts etc.? Feeling androgynous?
A disparity between what you know to be the truth and your external reality?  
Is there anything else you think your practitioner should know?