Intake form

Help us serve you better

Name *

Email address *

What type of services are you seeking?

Please select at least one option.

Psychological consulting

Psychosomatic consulting

Psychotherapy (CBT)

Retreats

Online diagnostics

What is your primary concern?

Have you previously sought any psychological or medical help?

If yes, please specify the type of help received.

How did you hear about exo vital GmbH?

What is your preferred method of consultation?

Please specify your availability for consultations.

Do you have any specific goals you wish to achieve through our services?

Are you currently taking any medications?

If yes, please list the medications.

Do you have any allergies or medical conditions we should be aware of?

Additional questions or comments

Sorry, we were not able to submit the form. Please review the errors and try again.

Exo Vital GmbH