Psychology Study Pre-Interview Intake Form
Personal Information
Full Name
Date of Birth
Gender
Female
Male
Non-binary
Other
Prefer not to say
Contact Email
Background Information
Occupation/Student Status
Highest Level of Education
How did you hear about this study?
Health & Wellbeing
Have you previously participated in psychological studies or therapy?
Yes
No
Are you currently receiving any psychological or medical treatment?
Yes
No
If yes, please specify:
Additional Information
What motivates you to participate in this study?
Any comments, concerns, or relevant information you wish to share?