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Ponte Into the Woods

Application - The Bridge to the Garden

Congratulations on your interest in

therapeutic follow-up program

The Bridge to the Garden!

This app is the first step towards living a life full of energy, without constantly feeling overwhelmed and behind on obligations, developing better and conflict-free relationships, improving your self-esteem so you can be proud of your progress, and achieving a healthy and fulfilling life, free from physical, emotional, and mental symptoms that prevent you from living well.

IMPORTANT: Completing the application DOES NOT GUARANTEE your spot. I or someone from my team will review each application individually and, if you are approved, will contact you with the next steps.

ATTENTION: This form is PART OF YOUR INITIAL ASSESSMENT. I need to understand your current situation and health status to determine if the program is the best path for you at this time. Therefore, the more detailed your information, the better. Please answer the questions carefully! To do this, set aside about 30 minutes to complete the application carefully to increase your chances of being approved.

Good luck! Hugs,

Dr. Cassandra Lyra, PhD

Sex
Feminine
Masculine
Other
I prefer not to say.
Date of birth
Month
Day
Year
Marital status
Single
Married or in a stable relationship
Separated or Divorced
Widow/Widower
Are you a caregiver for someone in your family? Check all that apply.
Are you working?
Yes, with fixed hours.
Yes, with flexible hours.
No, I am on leave from work.
No, I am unemployed.
No.
Are you having relationship difficulties at work or at home?
Yes a lot.
Yes, more or less.
Yes, a little.
No.
What is your monthly per capita family income?
Up to R$3,000.00.
R$3,000.00 to R$6,000.00
R$6,000.00 to R$10,000.00
R$10,000.00 to R$20,000.00
Above R$20,000.00
Check all the physical symptoms you've had in the last year.
Check all the emotional symptoms you've experienced this past year.
Check all the mental health symptoms you've experienced in the last year.
Do these symptoms prevent you from carrying out your daily activities at home or at work?
Yes a lot.
Yes, moderately.
Yes, a little.
No, but I do the activities while suffering.
No, I do the activities calmly.
I HAVE NO SYMPTOMS
Have these symptoms ever caused you to miss work?
Yes, often.
Yes, rarely.
No, but I'm suffering at work.
No, I work calmly.
I HAVE NO SYMPTOMS.
I DON'T HAVE A JOB.
Considering the treatment that yielded the best results, what was the outcome of that treatment for your symptoms?
It completely eliminated the symptoms.
It partially eliminated the symptoms.
It eliminated the symptoms, but then they came back.
It lessened, but did not eliminate the symptoms.
The symptoms did not improve at all.
I did not undergo treatment.
I HAVE NO SYMPTOMS
Are you interested in neuroscience?
Yes
No
I don't know the answer.
Do you have any prior knowledge of neuroscience?
Yes, I have in-depth knowledge of neuroscience.
Yes, I have some knowledge of neuroscience.
I have no knowledge of neuroscience.
Below, list the 3 most important things for you in your current life situation.
How did you find out about my work?
Are you preferably looking for an online or in-person therapeutic program? ATTENTION: the online modality has limitations regarding the resources available.
I prefer the online format.
I prefer the in-person format.
I have no preference.
How would you initially like to invest in the therapy program? Note: This answer does not determine how you will make the investment; it only indicates your initial preference.
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