Intake – Part XVIII Name(required) Email(required) Phone 1. Have you ever been exposed to extreme abuse or a traumatic experience? Did it have a drastic effect on your emotional or mental system? If so, what happened? How did it affect you? 2. Have you ever been diagnosed with Disassociative Identity Disorder (DID)? 3. Are you aware of any alters (other personalities) that you may have? If so, tell me about them. 4. Do you have a memory gap where you cannot remember a certain time of your life? 5. Do you have false memories of things that really didn't take place? 6. Have you ever been in a car accident or other traumatic situation? Have you ever witnessed a tragedy in real life? 7. Do you feel you were abducted by "aliens"? Explain. Submit Δ Like this:Like Loading...
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