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Questionnaire for Prospective Patients
Please read the following before answering the questions in this questionnaire:
The information which you provide will be held in the strictest confidence. Videotaping is done as part of therapy for in-house use only. Should Dr. Janov's Primal Center decide to publish any of the information or statistical data gathered from the questionnaire, you will not be personally identified. Please read each question carefully before you respond. You may print out this questionnaire and mail it to us, or complete it here, online (when you are done, click on the "E-mail Questionnaire" button at the bottom).
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