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Psychologist specializing in Rapid Transformation

Breathwork

Date
Day
Month
Year
Date of Birth
Day
Month
Year

In what degree do the following potential symptoms appear? Please choose from 1 to 10. 1 being minimum and 10 being maximum

Self-hatred / Lack of self-esteem
Crying (frequency and intensity)
Irrational negative emotions
Panic attacks / Anxiety (frequency and intensity)
Lack of energy
Suicidal thoughts
Deep sadness
Sleep problems
Feelings of hopelessness
Self-love
Moments of joy
Ability to control thoughts
Mood and laughter
Hope for the future
Ability to bring love and self-compassion to myself when I'm in a negative emotional state
Ability to observe and be present
General well-being
Healthy diet
Exercise
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