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Consultation Survey

Gender Required
I would like to be contacted on: Required
Tell us about your employment. Check all that apply. Required
We highly recommend therapeutic support as microdosing is dramatically enhanced by integration. We offer 15 min check ins and full sessions. Required
Mycology Psychology values communication, curiosity, and learning. Would you be interested in submitting feedback (short weekly surveys) intended for our use in establishing best therapeutic practices? Completing the feedback surveys has the added effect of stimulating awareness of where you are experiencing growth and change. Required
Are you currently in an ongoing therapy process? Required
Please rate your level of stressNoneLowMediumHighVery HighPlease rate your level of stress
How often do you feel anxiety?NeverNeverSometimesOftenVery OftenHow often do you feel anxiety?
How often do you feel depressed?NeverNeverSometimesOftenVery OftenHow often do you feel depressed?
How would you evaluate your emotional health?PoorPoorAverageAverageVery GoodHow would you evaluate your emotional health?
Do you have any addictions? Required
Have you ever been diagnosed with any of the following? Check all that apply. Required
Are you currently grieving or have you recently experienced a major loss? Required

Somatic : The Body

Are you currently experiencing any pain in your body? Required
How energized do you typically feel?Very LowVery LowVariableVariableVery Good and StableHow energized do you typically feel?
How would you rate the quality of your sex drive/libido?Very LowVery LowRegularRegularVery SatisfactoryHow would you rate the quality of your sex drive/libido?
Do you engage in physical exercise? Required
Do you engage in any routine body or energy work? (massage, chiropractics, qigong, acupuncture, etc.) Required
Do you take any medication? (Please include antidepressants and anxiolytics, with dosage and frequency) Required
How would you describe your diet? Check all that apply. Required
How would you evaluate your sleep? Check all that apply. Required
Do you take any sleeping aids / medication? Please specify. Required

Cognitive : The Mind

What is the quality of your focus and attention?PoorPoorAverageAverageVery GoodWhat is the quality of your focus and attention?
How would you describe your quality of mind?RigidRigidStuckStuckFlexible/OpenHow would you describe your quality of mind?
How organized do you generally feel?Very ChaoticChaoticSomewhat MethodicalMethodicalMethodicalHow organized do you generally feel?
What is your relationship to learning new things?Very DifficultDifficultA little FunSomewhat FunVery FunWhat is your relationship to learning new things?

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