Panimus Integration

Compassionate Inquiry Intake Form

Fields marked with an * are required

Name *

Email Address *

Phone Number *

Birthday

City & State of Residence *

Purpose & Intention - What are your goals, hopes, expectations for this work? What are you seeking? *

Mental Health - Please list all diagnosed psychological, psychiatric, and/or other mental health issues (Ex. depression, ADHD, PTSD, personality disorder, etc.) *

Medications - Please list all prescribed medications. Indicate which are currently being used and which had been previously used (ex: Adderall, Zoloft, etc.) *

Self-development - Please describe your current spiritual and/or self-development and wellness practices (Ex: meditation, journaling, yoga, prayer, breath-work, etc.).

Limitations - Do you have any physical conditions that limit your mobility or compromise your health?

Additional - Is there anything else you think we should know or that you would like to share with us?

[CI] How did you hear about us?

Compassionate Inquiry

The first step in getting started working with the Compassionate Inquiry modality is to fill out this intake form.

Compassionate Inquiry is very laser like in its focus and typically people make significant progress in just a few sessions.

Contact me with any specific questions or concerns.

eMail: paul@panimus.net