“Remember, you cannot abandon what you do not know. To go beyond yourself, youmust know yourself.”  Śri Nisargadatta Maharaj
We also need to get to know you better, that is why we would like to start with this short questionnaire
let's start
 
Before we proceed we need you to accept our terms *

By providing your contact details, you agree to be contacted by psychotherapist associated in DBT Center "Emotion".
I hereby declare that all the facts and information provided in this questionnaire are true. I allow my personal data stated in the questionnaire to be processed for the purpose of psychotherapy, in accordance with the Personal Data Protection Act dated 29/08/1997 (Dz.Ust.No.133, item 883)\".
     
 
Before we proceed we need you to consider to agree to our marketing terms (only offers from our Center, regarding mental health)

I hereby agree to receive business information by e-mail or phone number provided in this questionaire from therapists associated in DBT Center Emotions, Modzelewskiego 58a/104, 02-679 Warsaw, NIP: PL 5212967519, regon: 361275728)
     
 
What is your name stranger ?  (please give us your full name ) *

My name is Vivian Fiszer, and I work with a bunch of excellent DBT therapists
 
What kind of therapy ? *


 
the problem *


 
Describe your problems, or your needs regarding therapy (for example time) *

 
Choose your therapist *

Vivian's office is in Mokotow, Modzelewskiego (180 zł), the other therapists are based in the downtown of Warsaw - metro Politechnika (150-160zł),
If you don't know whom to choose please feel free to call me 507507333



 
Please give us, your telephone number, so we can call you *

Again, we promise not to call you in the middle of the night, or asking silly questions, or trying to sell you stuff
Dziękujemy za wypełnienie kwestionariusza, wybrany terapeuta skontaktuje się najszybciej, jak to będzie możliwe, do zobaczenia !
ważne informacje przed spotkaniem