History questionnaire couple

Welcome to the  Couples Medical History Questionnaire

Please take the time to answer the following questions as best you can. Each person fills out a form individually. If there are any questions (other than address and contact details) that you do not want to answer, simply leave them out. The information will help us to optimally prepare the meetings and to understand your topic. Of course they will be treated completely confidentially.

Thank you in advance for your time and trust.

If we have any questions about your comments, we will ask them at the next meeting.

With kind regards, Anika Schwenker & Andreas Thome

Family name
Given name
Street name and number
Postal code
Phone number