Please complete this questionnaire before your first EXOMIND session (it takes about 5 minutes). It helps us understand what you would like to improve, check whether the procedure is safe for you and prepare a personalised protocol. Your answers go directly to the BiohaQ medical team and are treated confidentially.
1. Contact details
2. What would you like to improve?

Tick the profiles that describe you (you can choose more than one).

3. How you have felt over the last 2 weeks

How much do sleep problems affect you?

How stressed do you feel?

How often do you feel sad, unmotivated or joyless?

How often do you feel restless or anxious?

How mentally tired do you feel?

How much do difficulties with concentration or memory affect you?

How strong are your food cravings or emotional eating?

4. Medical safety

These questions are mandatory. A “Yes” answer does not automatically mean you cannot have the therapy; the doctor will discuss it with you at the assessment.

Do you have any metal implants in the head or neck area (clips, plates, metal fragments; excluding dental work)?

Do you have a cochlear implant or an implanted hearing device?

Do you have a cardiac pacemaker, defibrillator, neurostimulator, drug pump or any other implanted electronic device?

Have you (or a first-degree relative) ever had epilepsy, seizures or unexplained loss of consciousness?

Have you had a head injury with loss of consciousness, a stroke, a brain tumour or brain surgery?

Are you pregnant, possibly pregnant or breastfeeding?

Do you have severe migraines or frequent headaches?

Are you currently receiving psychiatric or psychotherapeutic treatment?

In recent months, have you consumed excessive alcohol or recreational substances, or recently stopped such use abruptly?

This questionnaire is not a diagnosis and does not replace a medical consultation. If you are having thoughts of harming yourself, call 112 immediately.