Intake form

Welcome, feel free to fill in this intake form as long or brief as you deem necessary. It’s nice for us to have an idea of your wishes and history, but it’s also fine if this is discussed later. Only the questions with an asterisk are mandatory. Furthermore, we advise you not to see this as a boring form, but as a first reflection within your trajectory towards recovery or further development. Feel free to take a personal tone, or complain about the length of the form in the form!

Kind regards,
team Centrum Vaktherapie