ENGLISH ONLINE ROQYA DIAGNOSTIC

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COUNTRY* This field is required.
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I AM A...* This field is required.
MALEFEMALE
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AM I IN A RELATIONSHIP ?* This field is required.
YESNO
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AM I HAPPY IN MY RELATIONSHIP ?* This field is required.
YESNO
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OUR LIFE AS A COUPLE IS BALANCED, WE HAVE UPS AND DOWNS LIKE EVERYONE BUT NOTHING ABNORMAL.* This field is required.
YESNO
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I HAVE THE FEELING TO LOVE WHEN WE ARE FAR APART FROM EACH OTHER AND TO HATE HIM WHEN WE ARE CLOSE ?* This field is required.
YESNO
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THE NEXT DAY OR A FEW DAYS AFTER THE WEDDING CEREMONY, I FELT UNWELL* This field is required.
YESNO
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DO YOU FEEL THAT PEOPLE ARE JEALOUS OR WANT TO HURT YOUR RELATIONSHIP ?* This field is required.
YESNO
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SINCE A TRIP OR A FAMILY MEAL, THE CONDITION OF THE COUPLE HAS DETERIORATED* This field is required.
YESNO
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IN-LAWS DON’T WANT ME...* This field is required.
YESNO
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I LOVE MY SPOUSE/WIFE BUT ALL I WANT IS TO SEPARATE ?* This field is required.
YESNO
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I SMELL DISGUSTING AS SOON AS I AM NEAR MY SPOUSE/WIFE * This field is required.(WHILE HE HAS NO HYGIENE PROBLEMS)
YESNO
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I SPRINT THROUGH MARRIAGE AND DIVORCE FOR NO REASON* This field is required.
YESNO
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I WANT TO GET MARRIED BUT I AM TRANSPARENT, FEW PEOPLE CARE ABOUT ME* This field is required.
YESNO
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I SEEK TO MARRY BUT FEEL THAT I ONLY ATTRACT BAD PROFILES* This field is required.
YESNO
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PROBLEMS START AS SOON AS A SERIOUS PERSON TELLS ME ABOUT MARRIAGE* This field is required.
YESNO
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I FEEL DISGUST WHEN I HEAR ABOUT MARRIAGE* This field is required.
YESNO
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AS SOON AS MY LOVED ONES TALK TO ME ABOUT MARRIAGE, I GET ANGRY AND FEEL ANGER RISING INSIDE ME.* This field is required.
YESNO
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EVERY TIME I MEET SOMEONE, THEY DISAPPEAR FOR NO REASON* This field is required.
YESNO
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WHEN I START EXCHANGING WITH SOMEONE EVERYTHING GOES WELL, BUT AS SOON AS THEY TALK TO ME ABOUT MARRIAGE, I GET UPSET FOR NO REASON AND WANT TO STOP EVERYTHING* This field is required.
YESNO
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I AM ONLY ATTRACTED BY BAD PROFILES, I DON’T TRADE WITH THE RIGHT PEOPLE* This field is required.
YESNO
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I WORK* This field is required.
YESNO
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I HAVE MY OWN BUSINESS* This field is required.
YESNO
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MY TURNOVER DROPS FOR NO LOGICAL REASON* This field is required.
YESNO
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I LOVE MY JOB, BUT IT’S HEAVY TO GO TO* This field is required.
YESNO
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EVERY DAY WHEN I GO OUT TO WORK, I GET HEADACHE, TREMOR, NAUSEA* This field is required.
YESNO
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I CHANGE COMPANIES OFTEN BECAUSE I DEMOTIVATE VERY QUICKLY.* This field is required.
YESNO
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IN MY COMPANY, I FOUND SUSPICIOUS THINGS : TALISMANS, GRIGRI, KNOTS... AND SINCE NOTHING GOES WELL.* This field is required.
YESNO
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I CAN’T EVOLVE, LESS QUALIFIED PEOPLE HAVE PROMOTIONS OR CONTRACTS BUT I DON’T.* This field is required.
YESNO
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SINCE SOMEONE HAS BEEN WORKING WITH ME, I FEEL VERY BAD AND CANNOT REGAIN ALL MY FACULTIES.* This field is required.
YESNO
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I SENT MANY CVS BUT HAVE NO ANSWERS.* This field is required.
YESNO
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DURING MY INTERVIEWS IT GOES VERY WELL, BUT I NEVER HAVE THE JOB OR THE CONTRACT* This field is required.
YESNO
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I AM MOTIVATED TO LOOK FOR WORK BUT AM STUCK AT HOME.* This field is required.
YESNO
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I HAVE EXPERIENCE AND DEGREES BUT HAVE NO PROPOSAL* This field is required.
YESNO
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I HAVE NO MOTIVATION TO WORK, PREFER TO DO NOTHING* This field is required.
YESNO
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AS SOON AS IT’S POSITIVE FOR A POSITION, I DON’T WANT TO GO ANYMORE, OR I STAY FOR A FEW DAYS AND QUIT* This field is required.
YESNO
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I BELIEVE IN ALLAH, GOD* This field is required.
YESNO
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I AM INTERESTED IN RELIGION BUT AM STUCK* This field is required.
YESNO
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I PRACTICE MY RELIGION AND TRY TO PROGRESS AS I CAN* This field is required.
YESNO
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I CAN’T PRACTICE ANY RELIGIOUS ACTION, FASTING OR PRAYER WHEN I USED TO PRACTICE.* This field is required.
YESNO
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I DO MY ABLUTIONS TO PRAY BUT CANNOT PRAY* This field is required.
YESNO
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WHEN I PRAY, I HEAR SLANDER TOWARDS ALLAH (GOD)* This field is required.
YESNO
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I PRACTICE MY RELIGION BUT AM TOO ATTRACTED TO BAD DEEDS: ALCOHOL, FORNICATION, GAMBLING...* This field is required.
YESNO
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I HAVE PLANS TO CHANGE MY RELIGION.* This field is required.
YESNO
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I NO LONGER BELIEVE IN ISLAM OR ANY RELIGION.* This field is required.
YESNO
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I HAVE DOUBTS ABOUT THE EXISTENCE OF ALLAH (GOD) WHEN I HAD NONE.* This field is required.
YESNO
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I STOPPED THE PRAYER FOR NO REASON AND CANNOT TAKE BACK.* This field is required.
YESNO
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I DO NOT PRACTICE RELIGION, EVEN IF I BELIEVE IN ALLAH (GOD)* This field is required.
YESNO
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WHEN I LISTEN TO THE KORAN I DON’T FEEL WELL AND WANT TO TURN OFF* This field is required.
YESNO
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WHILE PRAYING I MAKE UNCONTROLED GESTURES* This field is required.
YESNO
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I ENJOY BEING WITH FRIENDS OR FAMILY* This field is required.
YESNO
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WE ARE A UNITED FAMILY, AND WE LIKE TO BE TOGETHER.* This field is required.
YESNO
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I SPEND THE DAY ALONE AT HOME WITH THE SHUTTERS CLOSED IN THE DARK.* This field is required.
YESNO
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NO ONE CARES ABOUT ME, FRIENDS OR FAMILY.* This field is required.
YESNO
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I AM ALONE BUT IT IS A LIFE CHOICE* This field is required.
YESNO
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I CAN’T KEEP FRIENDS LONG.* This field is required.
YESNO
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AS SOON AS I AM WITH THE CROWD, I AM STUNNED AND ONLY WANT TO LEAVE THE PLACE* This field is required.
YESNO
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I AM IN A RELATIONSHIP* This field is required.
YESNO
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I WAS PREVIOUSLY MARRIED * This field is required.QUESTIONS WILL FOCUS ON YOUR PREVIOUS MARRIAGE
YESNO
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I HAVE NEVER BEEN MARRIED AND AM NOT IN A RELATIONSHIP* This field is required.
YESNO
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WE HAVE BALANCED INTIMACY, EVERYTHING GOES WELL.* This field is required.
YESNO
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ON THE FIRST NIGHT OF THE WEDDING I WAS STUCK, IMPOSSIBLE TO HAVE INTIMACY.* This field is required.
YESNO
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I HAVEN’T HAD A PHYSICAL INTIMACY WITH MY SPOUSE/WIFE FOR A LONG TIME* This field is required.
YESNO
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I CAN SPEND LONG PERIODS WITHOUT DESIRE.* This field is required.
YESNO
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I HAVE NO DESIRE OR LIBIDO WITH MY SPOUSE/WIFE BUT I FEEL IT WITH PEOPLE OUTSIDE MY RELATIONSHIP.* This field is required.
YESNO
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WHEN WE HAVE SEX I HAVE BIG PAIN IN THE INTIMATE AREAS.* This field is required.SENSATION OF CUTTING BLADES OR BURNS
YESNO
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I NO LONGER FEEL ANY PLEASURE, I SIMULATE MY SPOUSE/WIFE.* This field is required.
YESNO
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I HAVE NO OR LITTLE DESIRE, MY LIBIDO IS LOW.* This field is required.
YESNO
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I NO LONGER ACCEPT ANY CONTACT WITH MY SPOUSE/WIFE FOR NO VALID REASON.* This field is required.
YESNO
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DESPITE INTIMACY IN MY RELATIONSHIP, I HAVE URGES AND NEED TO WATCH EROTIC MOVIES TO RELIEVE MYSELF.* This field is required.
YESNO
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I HAVE AN EXTREME DESIRE FOR INTIMACY OF UP TO MORE THAN 5 TIMES A DAY.* This field is required.
YESNO
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THE HUSBAND MANAGES TO HAVE AN ERECTION, BUT AS SOON AS HE GETS CLOSE TO HIS WIFE, HE LOSES IT.* This field is required.
YESNO
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MAN BECAME POWERLESS OVERNIGHT* This field is required.
YESNO
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THE WOMAN HAS VAGINAL DRYNESS FOR NO REASON IN HER RELATIONSHIP WITH HER HUSBAND* This field is required.
YESNO
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FROM TIME TO TIME I SEE MY SPOUSE/WIFE WITH AN UGLY AND DARK FACE* This field is required.
YESNO
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I AM IN A RELATIONSHIP BUT IT’S STRONGER THAN ME, I NEED TO WATCH PORNOGRAPHIC VIDEOS.* This field is required.
YESNO
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I AM IN A RELATIONSHIP BUT IT IS STRONGER THAN ME, I PRACTICE ADULTERY* This field is required.
YESNO
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I HAVE HOMOSEXUAL IDEAS AND DESIRES.* This field is required.
YESNO
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I AM NOT IN A RELATIONSHIP AND MANAGE TO PRESERVE MYSELF AS I CAN.* This field is required.
YESNO
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I AM ATTACHED TO PORNOGRAPHY TO RELIEVE MYSELF ALONE* This field is required.
YESNO
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I AM NOT MARRIED AND UNABLE TO PRESERVE MYSELF: SEX WITH PARTNERS* This field is required.
YESNO
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I HAVE NO PARTICULAR FINANCIAL PROBLEMS.* This field is required.
YESNO
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I MANAGE TO COPE WITH PARTICULAR DIFFICULTIES.* This field is required.
OUINON
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I MAKE A DECENT LIVING BUT AM STILL OVERDRAWN AND NOT SPENDING.* This field is required.
YESNO
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* This field is required.
YESNO
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I AM STILL IN DEBT AND CANNOT GET OUT OF IT* This field is required.
YESNO
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AS SOON AS I CAN SAVE, SOMETHING HAPPENS TO ME AND I LOSE MY SAVINGS* This field is required.
YESNO
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I HAVE URGES AND SPEND MY MONEY IN HARAM (DRUGS, GAMBLING, SEX…)* This field is required.
YESNO
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I CAN’T KEEP MY MONEY, UNTIL I GET TO ZERO, I KEEP SPENDING.* This field is required.
YESNO
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PEOPLE THINK I HAVE MONEY, THEY ARE STILL QUESTIONING ME AND SINCE I CAN’T KEEP MY MONEY.* This field is required.
YESNO
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I AM TIRED ALL THE TIME WITHOUT ANY REAL CAUSE.* This field is required.
YESNO
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I ALWAYS PUT EVERYTHING OFF TO THE NEXT DAY.* This field is required.
YESNO
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I START BUT NEVER FINISH.* This field is required.
YESNO
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I’M BLOCKED TO PASS MY DRIVING LICENSE OR DIPLOMA* This field is required.
YESNO
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EVERYTHING I DO FALLS DOWN, MY PROJECTS NEVER SUCCEED.* This field is required.
YESNO
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MY LIFE GOES SMOOTHLY WITH UPS AND DOWNS LIKE EVERYONE ELSE.* This field is required.
YESNO
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I AM ALWAYS TIRED AND WANT TO SLEEP.* This field is required.
YESNO
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I ADVISE MY LOVED ONES ON THEIR PROJECT AND THEY SUCCEED, BUT I CAN’T.* This field is required.
YESNO
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IT FEELS LIKE I’M STANDING AND NOT MOVING FORWARD.* This field is required.
YESNO
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I ONLY WANT TO SLEEP ALL DAY* This field is required.
YESNON
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I WAS A DYNAMIC AND ACTIVE PERSON AND SUDDENLY LOST ALL MY ENERGY* This field is required.
YESNO
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I AM A TOP SPORTSMAN, I’M GOOD AT SPORTS TRAINING BUT AT THE TIME OF THE COMPETITION I DO NOT SUCCEED* This field is required.
YESNO
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DO YOU OFTEN HAVE HEADACHE ?* This field is required.
YESNO
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YOUR HEADACHE OCCURS THROUGHOUT THE DAY* This field is required.
YESNO
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YOUR HEADACHE STARTS AT NIGHTFALL* This field is required.
YESNO
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DO YOU HAVE STOMACHACHE ?* This field is required.
YESNO
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ARE YOUR STOMACHACHE UNEXPLAINED BY MEDICINE ?* This field is required.
YESNO
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HAVE MANY BURPS IN THE DAY?* This field is required.
YESNO
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HAVE MANY GASES IN THE DAY?* This field is required.
YESNO
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DO YOU HAVE BACK PAIN?* This field is required.WHILE YOU DON’T FORCE ON YOUR BACK
YESNO
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MY BACK PAIN IS IN THE LOWER BACK?* This field is required.
YESNO
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MY BACK PAIN IS UNEXPLAINED BY DOCTORS?* This field is required.
YESNO
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DO YOU HAVE ANY SKIN PROBLEMS?* This field is required.
YESNO
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DO YOU HAVE PSORIASIS?* This field is required.
YESNO
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DO YOU HAVE ECZEMA?* This field is required.
YESNO
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DO YOU HAVE VITILIGO?* This field is required.
YESNO
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DO I HAVE SKIN STAINS?* This field is required.
YESNO
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DO I HAVE SEVERE ACNE ON MY FACE?* This field is required.
YESNO
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DO YOU HAVE HAIR PROBLEMS ?* This field is required.
YESNO
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I LOSE MY HAIR EXTREMLY* This field is required.
YESNO
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I EAT THE BULBS OF MY HAIR* This field is required.
YESNO
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MY HAIR HAS COMPLETELY CHANGED* This field is required.
YESNO
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ARE YOU HAVING FEEDING PROBLEMS?* This field is required.
YESNO
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I LOSE A LOT OF WEIGHT FOR NO REASON* This field is required.
YESNO
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I GAINED A LOT OF WEIGHT* This field is required.
YESNO
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I AM A BULIMIC* This field is required.I EAT AND VOMIT IMMEDIATELY AFTERWARDS
YESNO
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I AM ANOREXIC* This field is required.
YESNO
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I WAKE UP AT NIGHT TO EAT* This field is required.
YESNO
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I HAVE LEG PAIN* This field is required.
YESNO
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I HAVE AN UNEXPLAINED FOOT DISEASE BY DOCTORS* This field is required.
YESNO
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FEELING TINGLING IN MY LEGS* This field is required.
YESNO
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MY LEGS TREMBLE LISTENING TO THE QUR'AN* This field is required.
YESNO
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MY LEGS ARE BLOCKED FOR NO MEDICAL REASON* This field is required.
YESNO
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I HAVE A WOUND IN MY LEG THAT DOES NOT CLOSE FOR ANY MEDICAL REASON* This field is required.
YESNO
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I HAVE UNEXPLAINED FOOT DISEASE* This field is required.
YESNO
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AS SOON AS THE SUN GOES DOWN, I FEEL BAD.* This field is required.
YESNO
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I SLEEP WELL AT NIGHT* This field is required.
YESNO
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I SPEAK AT NIGHT IN MY SLEEP.* This field is required.
YESNO
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GRINDING MY TEETH AT NIGHT WHILE SLEEPING* This field is required.
YESNO
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I HAVE NIGHTMARES WHILE SLEEPING.* This field is required.
YESNO
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DO YOU HAVE EPILEPTIC SEIZURES ?* This field is required.
YESNO
152
ARE YOU HAVING TETANY SEIZURES ?* This field is required.
YESNO
153
DO YOU HAVE AN UNEXPLAINED MEDICAL ILLNESS?* This field is required.
YESNO
154
DO YOU HAVE AN ELDERLY DISEASE WHILE YOU ARE UNDER AGE?* This field is required.
YESNO
155
ARE YOU TRYING TO HAVE A CHILD?* This field is required.
YESNO
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I HAVE ONE CHILD BUT CAN’T GET ANY MORE?* This field is required.
YESNO
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THE WOMAN HAS NO MORE PERIODS OR THEY ARE UNBALANCED?* This field is required.
YESNO
158
MULTIPLYING MISCARRIAGES* This field is required.
YESNO
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DOES THE WOMAN HAVE UNEXPLAINED DISEASES IN THE UTERUS OR OVARIES?* This field is required.
YESNO
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MANY OF YOUR CHILDREN HAVE A DISABILITY OR AN ORPHAN DISEASE * This field is required.
YESNO
161
DO YOU HEAR VOICES?* This field is required.
YESNO
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DO YOU OFTEN HEAR YOUR FIRST NAME WHEN THERE IS NO ONE THERE ?* This field is required.
YESNO
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DO YOU HAVE VISIONS DURING THE DAY?* This field is required.
YESNO
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DO YOU HAVE VISIONS AT NIGHT?* This field is required.
YESNO
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DO YOU OFTEN CRY FOR NOTHING?* This field is required.
YESNO
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DO YOU SUFFOCATE WHEN THERE ARE TOO MANY PEOPLE?* This field is required.
YESNO
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DO YOU ALWAYS THINK OF DEATH?* This field is required.EXAGGERATED AND MAKES YOU LOSE ALL YOUR LIFE FORCE
YESNO
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AT THE SLIGHTEST PAIN DO YOU THINK YOU HAVE A SERIOUS ILLNESS?* This field is required.
YESNO
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DO YOU ALWAYS THINK YOUR LOVED ONES ARE GOING TO GET HURT?* This field is required.
YESNO
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DO YOU FEEL PRESENCES AROUND YOU?* This field is required.
YESNO
171
DO YOU HAVE A STRONG DESIRE FOR SUICIDE?* This field is required.
YESNO
172
HAVE YOU ATTEMPTED SUICIDE?* This field is required.
YESNO
173
DO YOU HAVE OCD (YOU REPEAT AN ACTION SEVERAL TIMES)?* This field is required.
YESNO
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DO YOU FEEL THINGS TOUCHING YOU?* This field is required.
YESNO
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DO YOU THINK YOU ARE THE OBJECT OF A PLOT?* This field is required.
YESNO
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DO YOU THINK YOU HAVE A PLANETARY MISSION (BEING A PROPHET, THE MAHDI, ANGELS...)?* This field is required.
YESNO
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OFTEN OUTSIDE PEOPLE WANT TO CONFUSE YOU OR FIGHT YOU FOR NOTHING?* This field is required.
YESNO
178
YOU NO LONGER FEEL ANY EMOTION?* This field is required.WHETHER IN HAPPINESS OR UNHAPPINESS
YESNO
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DO YOU REGULARLY HEAR INSULTS TO ALLAH OR ISLAM IN YOUR HEAD?* This field is required.
YESNO
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DO YOU HAVE ANY DESIRE TO PLUCK YOUR HAIR: HAIR, BEARD, LASHES...?* This field is required.
YESNO
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AM I ATTRACTED TO THE FIELD OF CLAIRVOYANCE AND WITCHCRAFT ?* This field is required.AN URGE TO WORK WITH THE PARANORMAL
YESNO
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DO YOU DREAM OF GRAVEYARD, DEATH, DEATH PRAYER?* This field is required.
YESNO
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DO YOU DREAM OF FLYING LIKE BIRDS?* This field is required.
YESNO
184
DO YOU DREAM OF FALLING DOWN?
YESNO
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DO YOU DREAM OF WATER, THE SEA, SWIMMING, DROWNING?* This field is required.
YESNO
186
DO YOU HAVE DREAMS OF BEING SUED?* This field is required.
YESNO
187
DO YOU HAVE SLEEP PARALYSIS?* This field is required.Impossible de crier, de respirer
YESNO
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ARE YOU HAVING FIGHT DREAMS?* This field is required.
YESNO
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DO YOU DREAM OF THE POLICE OR THE ARMY?* This field is required.
YESNO
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DO YOU HAVE SNAKE DREAMS?* This field is required.
YESNO
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DO YOU DREAM ABOUT VEHICLES?* This field is required.CAR, BOAT, PLANE, TRAIN...
YESNO
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DO YOU DREAM OF A CAR THAT DOESN’T BRAKE?* This field is required.
YESNO
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DO YOU HAVE TRAVEL DREAMS?* This field is required.
YESNO
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DO YOU OFTEN HAVE INTIMATE, SEXUAL DREAMS?* This field is required.AT LEAST ONCE A WEEK
YESNO
195
DO YOU HAVE DREAMS OF BLOOD?* This field is required.NORMAL BLOOD OR MENSTRUAL
YESNO
196
DO YOU DREAM OF TOILET, URINE, FECES?* This field is required.
YESNO
197
DO YOU HAVE DREAMS OF DOGS/CATS ATTACKING YOU?* This field is required.
YESNO
198
DO YOU HAVE FELINE DREAMS ?* This field is required.
YESNO
199
DO YOU HAVE SPIDER DREAMS?* This field is required.
YESNO
200
DO YOU HAVE TSUNAMI DREAMS?* This field is required.
YESNO
201
DO YOU HAVE END-OF-WORLD DREAMS?* This field is required.
YESNO
202
WHEN I DREAM, I LIVE ANOTHER LIFE WITH ANOTHER FAMILY.* This field is required.
YESNO
203
I DREAM SATANIC RITUALS.* This field is required.
YESNO
204
HAVE YOU EVER FOUND ANYTHING SUSPICIOUS IN YOUR HOME?* This field is required.NOEUDS, TALISMANS, PHOTOS, CHEVEUX, ...
YESNO
205
DID YOU FIND TRACES OF VAPORIZATION ON YOUR FRONT DOOR?* This field is required.
YESNO
206
DID YOU FIND ANY STRANGE LEAD PLATES IN YOUR HOME?* This field is required.
YESNO
207
HAVE YOU WORN TALISMANS: GRIGRI, HIRZ, TAHWIZ, MOUCHKA?* This field is required.
YESNO
208
DID YOU GO TO SEE ANY FORTUNE TELLERS?* This field is required.
YESNO
209
HAVE YOU VISITED MARABOUTS, FQIHS...?* This field is required.
YESNO
210
HAVE YOU GONE TO SEE HEALERS WHO ASK FOR YOUR MOTHER’S FIRST NAME...?* This field is required.
YESNO
211
HAVE YOU EVER MADE SACRIFICES OF ANIMALS (ROOSTER, SHEEP, OXEN...), TO SUPPOSEDLY CARE FOR YOU OR BRING GOOD LUCK?* This field is required.
YESNO
212
HAVE YOUR PARENTS EVER MADE SACRIFICES OF ANIMALS (ROOSTER, SHEEP, OXEN...) TO SUPPOSEDLY HEAL OR BRING GOOD FORTUNE?* This field is required.
YESNO
213
HAVE YOU EVER PERFORMED A VIRGINITY RITUAL?* This field is required.THE GIRL IS ASKED TO DO A SPECIFIC ACTION, SO THAT SHE DOES NOT LOSE HER VIRGINITY BEFORE THE WEDDING
YESNO
214
DO YOU OFTEN READ YOUR ASTROLOGICAL SIGN?* This field is required.
YESNO
215
ARE YOU WEARING A HAND OF FATMA TO PROTECT YOURSELF? * This field is required.IT’S HARAM!
YESNO
216
ARE YOU WEARING AN EYE-SHAPED PENDANT TO PROTECT YOURSELF?* This field is required.IT’S HARAM!
YESNO
217
HAVE YOU GIVEN (LOST) CLOTHES WITH YOUR BODY ODOR TO PEOPLE WHO HAVE ASKED YOU?* This field is required.
YESNO
218
DO YOU OFTEN SHOW YOUR FACE ON SOCIAL MEDIA?* This field is required.
YESNO
219
DO YOU OFTEN GET FOOD SPECIFICALLY FOR YOU?* This field is required.
YESNO
220
HAVE YOU MADE "PURIFICATIONS" WITH INCENSE HAVING A BAD SMELL?* This field is required.
YESNO
221
HAVE YOU EVER WASHED WITH BLACK OR BAD WATER FROM A "HEALER"?* This field is required.
YESNO
222
DID YOU PERFORM A LEAD RITUAL WITH A PERSON INTERPRETING LEAD?* This field is required.
YESNO
223
WHILE ANSWERING THE FORM: DID YOU FEEL UNCOMFORTABLE OR FELT STRANGE?* This field is required.
YESNO
224
Score
225
WHAT DO YOU THINK ABOUT THE DIAGNOSIS? MOVE THE EMOJI TO GIVE YOUR OPINION* This field is required.
UNDERSTANDING OF QUESTIONS
LENGTH OF DIAGNOSIS
SUBJECT MATTER
Row 0, Column 0Row 0, Column 1Row 0, Column 2
Row 1, Column 0Row 1, Column 1Row 1, Column 2
Row 2, Column 0Row 2, Column 1Row 2, Column 2
UNDERSTANDING OF QUESTIONS
LENGTH OF DIAGNOSIS
SUBJECT MATTER
Row 0, Column 0Row 0, Column 1Row 0, Column 2
Row 1, Column 0Row 1, Column 1Row 1, Column 2
Row 2, Column 0Row 2, Column 1Row 2, Column 2
226
YOUR COMMENTS FOR IMPROVEMENT
227
CLICK ON THE AMOUNT* This field is required.Please wait after payment to get the result.
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