Registering for The Mindset Group, LLC.
Mindset relies on lots of feedback from you, the user, in order to make continuous improvement in the quality of the assistance and service we deliver.  That is why we will now be asking you a lot of nosy questions before you can use the program.  This information will be used internally only, to determine how effective Mindset is for different types of people. 

Per our Terms of Service, Mindset agrees never to share your personal information with any external partner or organization for marketing purposes, and will never expose your identity to anyone.  We will use the evidence of your success here, however, to encourage others who might benefit from our services to do so.

First Name:
Last Name:
eMail Address:
Gender:
Date of Birth:
Country of Birth:
Race:
Highest level of education completed:
Marital status:
Parental Status:  
Sexual Orientation: (hetero, gay, lesbian, bi, transgendered)
Occupation:
Income:
Prior psychotherapy experience:  
Level of improvement: obtained (ranges)
Medication treatment: (current & past)
Level of improvement obtained: (ranges)
Psychiatric hospitalization: (number of occurrences and duration in days for each)
Religion (type and strength)
   
 
 
 

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