Therapy Feedback

from Dr. Dr. med. Herbert Mück
Facharzt für Psychotherapeutische Medizin - Sportmedizin
(51061 Köln, Tel. 0221/607461, Fax 607474
Homepage: www.dr-mueck.de, E-Mail: kontakt@dr-mueck.de

For Mr./Mrs...............................................................

Next Meeting:

Date:....................................

Time:...................................

Please be aware that you will have to pay a missed meeting if you have not cancelled it at least one week in advance!

Please bring this sheet as a reminder to our next meeting

For the sake of your early recovery and your personal development I recommend to you the following measures:

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Since you are and will stay the "boss" it will always be you, who decides which of these suggestions you would like to implement and which you won't. Both responsibility and success are in your hands.

PLEASE REMEMBER ALWAYS TO SEND ME A "MEETING FEEDBACK" AFTER EACH MEETING!

Please consider........................................................................................................................

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My observation:............................................................................................................................

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Quotation (what you yourself said spontaneously): .........................................................................

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My emotional reaction:……….......................................................................................................

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Questions coming up in me:..............................................................................................................

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Current and former events worth remembering:……........................................................................

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Miscellaneous...........................................................................................................................................

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Köln, .................................. Your Dr. Dr. Herbert Mück