Mind/Body wellness

Your First Name
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Your Last Name
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Phone Number
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Your E-mail Address
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The purpose of this questionnaire is to help understand the potential link between physical and emotional health. It serves to help the facilitator in determining what changes can be made to your diet and behavior to improve overall wellbeing.
How would you rate your current physical health?
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Are you currently experiencing overwhelming sadness, grief, or depression?
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Over the past 2 weeks, how often have you been bothered by any of the following problems:
Trouble falling asleep, staying asleep, or sleeping too much.
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Feeling tired or having little energy.
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Poor appetite or overeating.
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Feeling bad about yourself or that you are a failure or have let yourself or your family down.
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Trouble concentrating on things, such as reading the newspaper or watching tv.
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Are you currently experiencing anxiety, panic attacks or have any phobias?
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Are you currently taking any medication?
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Are you currently experiencing any chronic pain?
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  • - How do you prefer to communicate with Dr. David? -
  • Live in Dubai or Lebanon
  • Via video sessions
- How do you prefer to communicate with Dr. David? -
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