BASIC INFORMATION

First and Last Name

Age:

Marital status: (how many marriages, divorces)

Preparatory Questionnaire (name and year of birth):

Abortions (misscarriage and induced):

IVF - yes; no

TOPIC / GOAL

What is the topic that brings you here?

hat would you like to change, clarify, or initiate through this constellation?

PERSONAL HISTORY (brief)

Did your mother deliver you as a baby without any problems? *

What was your parents’ marriage like (from your perspective)? 

Do you have brothers and sisters, and what is your birth order? 

Have you experienced significant traumatic events ?

Have you been married / in serious relationships before your current situation? Do you have children from those relationships?

Does your current partner have children from previous relationships/marriages? Has he/she had a marriage or significant relationship before?

Are there any significant events from your childhood that you consider important?

Are you currently taking any medications?

Are you healthy?

FAMILY HISTORY - parents

Are they alive?

Are they still together/married? 

Did your parents have previous marriages before each other; miscarriages, children who did not grow up? 

Did either of your parents suffer a major loss (a parent at an early age, a sibling)? 

Do your mother and father have brothers and sisters, and what is their birth order?

GRANDPARENTS: 

Do you know anything about their lives?

Did they participate in war, experience exile, poverty, losses, were in a camp/survived one?

Did they have children who died young? 

id grandmothers have miscarriages (induced or misscarriages)? 

Did they have previous marriages before their own?

GREAT-GRANDPARENTS: List anything you know about any of them.

OTHER IMPORTANT FAMILY MEMBERS: 

Were there members who were: Excluded or forgotten? Labeled as the “black sheep”? Suffered from mental illness, addictions, disabilities? Perpetrators or victims of violence? Committed murder/suicide, involved in an accident, caused or were victims of one? Alcoholics? Adopted or illegitimate children?

SYMPTOMS AND REPEATING PATTERNS

Is there any pattern that repeats in your family?

Do you feel like you are carrying “other people’s feelings,” a “burden” that is not yours? 

Do you feel like something in you “does not belong” or that you “don’t have your place”?

OTHER

Have you already participated in systemic constellations?

Note: The information from this questionnaire will be used exclusively for the purpose of thorough preparation and facilitation of the systemic constellation.

Sačuvano kao uzorak

Note: The information from this questionnaire will be used exclusively for the purpose of thorough preparation and facilitation of the systemic constellation.

Facilitator of systemic constellations Kristina Ercegović, EMBA, www.kristinaercegovic.com

Preparatory Questionnaire for a Constellation Session

BASIC INFORMATION

TOPIC / GOAL

PERSONAL HISTORY (brief)

FAMILY HISTORY - parents

GRANDPARENTS:

OTHER IMPORTANT FAMILY MEMBERS:

SYMPTOMS AND REPEATING PATTERNS

OTHER

U poduzetništvu je najvažnije putem (p)ostati čovjek.

Kristina Ercegovic

Drugi projekti:

Preparatory Questionnaire for a Constellation Session

BASIC INFORMATION

TOPIC / GOAL

PERSONAL HISTORY (brief)

FAMILY HISTORY - parents

GRANDPARENTS:

OTHER IMPORTANT FAMILY MEMBERS:

SYMPTOMS AND REPEATING PATTERNS

OTHER

FAMILY HISTORY - parents

GRANDPARENTS: 

OTHER IMPORTANT FAMILY MEMBERS: 