{"id":1958,"date":"2020-04-04T20:10:56","date_gmt":"2020-04-04T18:10:56","guid":{"rendered":"https:\/\/rrygm.beeweb-green.io\/?page_id=1958"},"modified":"2024-03-27T20:50:44","modified_gmt":"2024-03-27T19:50:44","slug":"inntaksskjema","status":"publish","type":"page","link":"https:\/\/tre-online.com\/nb\/tre-online-learn-how-to\/intake-form\/","title":{"rendered":"L\u00e6ring TRE\u00ae: Inntaks-\/avsl\u00f8ringsskjema"},"content":{"rendered":"<div class=\"wp-block-media-text alignwide is-stacked-on-mobile\" style=\"grid-template-columns:45% auto\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"https:\/\/tre-online.com\/wp-content\/uploads\/2020\/04\/LogoStress_noExerc3.jpg\" alt=\"\" class=\"wp-image-1971 size-full\"\/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"wp-block-paragraph\"><strong>ERSTATNINGSFRIHET<\/strong><br>TRE\u00ae er ikke ment for \u00e5 diagnostisere, behandle, kurere eller forebygge noen sykdom. TRE\u00ae er en trygg og effektiv avspenningsteknikk for de fleste mennesker.<\/p>\n<\/div><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">TRE\u00ae-prosessen skal ikke brukes som en erstatning for traumebehandling av medisinsk eller psykiatrisk\/psykologisk art. Personer som har fysiske eller psykiske tilstander som krever streng regulering, personer med skj\u00f8rt psykologisk forsvar, en kompleks traumehistorie eller begrensende fysiske eller medisinske begrensninger, b\u00f8r r\u00e5df\u00f8re seg med helsepersonell f\u00f8r de utf\u00f8rer disse \u00f8velsene. Resultatene kan variere fra person til person. Det gis ingen garantier, verken uttrykt eller underforst\u00e5tt.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>KONFIDENSIALITET<\/strong><br>Alt som diskuteres i l\u00f8pet av den tiden vi arbeider sammen, skal forbli konfidensielt og skal ikke avsl\u00f8res til noen tredjepart, med unntak av den henvisende behandleren. Hvis du deltar i gruppearbeid, skal ikke identifiserbart materiale avsl\u00f8res utenfor gruppen.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>RELEASE<\/strong><br>Jeg erkjenner at jeg frivillig deltar i en privat- eller gruppesesjon i TRE<strong>\u00ae<\/strong> av egen fri vilje. Jeg er klar over at jeg ved \u00e5 praktisere TRE<strong>\u00ae<\/strong>Jeg p\u00e5tar meg og aksepterer risikoen for eventuelle negative utfall som kan oppst\u00e5. Jeg forst\u00e5r at jeg kan avbryte deltakelsen n\u00e5r jeg vil, og at jeg har kontroll over intensiteten jeg utf\u00f8rer TRE<strong>\u00ae<\/strong>. Jeg tar fullt ansvar for eventuelle bivirkninger eller endringer i livet mitt som f\u00f8lge av TRE<strong>\u00ae<\/strong> kan for\u00e5rsake.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Jeg er klar over at selv om Deva Laya Guleng er en sertifisert TRE<strong>\u00ae<\/strong> Tilbyder\/veileder er ikke en autorisert lege og gir derfor ikke medisinske r\u00e5d. Jeg erkjenner at hun ikke anbefaler at jeg slutter \u00e5 bruke foreskrevet medisin, behandling eller psykisk helsehjelp uten \u00e5 r\u00e5df\u00f8re meg med legen eller r\u00e5dgiveren min.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Jeg samtykker i \u00e5 ta fullt ansvar for min egen fysiske og emosjonelle helse og holder Deva Laya Guleng og OmniBalance skadesl\u00f8se fra ethvert juridisk, \u00f8konomisk og medisinsk ansvar som m\u00e5tte oppst\u00e5 som f\u00f8lge av l\u00e6ringsprosessen min.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>L\u00c6RE BORT TRE\u00ae TIL ANDRE<\/strong><br>Jeg erkjenner at jeg ikke er en sertifisert leverand\u00f8r av TRE<strong>\u00ae<\/strong> etter \u00e5 ha deltatt p\u00e5 en-til-en-timer eller gruppetimer, og er derfor ikke oppl\u00e6rt til \u00e5 l\u00e6re andre hvordan man gj\u00f8r det etter \u00e5 ha deltatt p\u00e5 timen (privat\/gruppe). Hvis jeg underviser TRE<strong>\u00ae<\/strong>aksepterer jeg fullt ansvar for ethvert krav, s\u00f8ksm\u00e5l eller prosedyre som reises mot meg av noen jeg underviser, og frigj\u00f8r dermed Deva Laya Guleng, OmniBalance, TRE<strong>\u00ae<\/strong> LLC, og Dr. David Berceli fra ethvert juridisk, \u00f8konomisk og medisinsk ansvar som m\u00e5tte p\u00e5l\u00f8pe.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>KONTRAINDIKASJONER<\/strong><br>Det er kontraindisert \u00e5 bruke TRE\u00ae hvis du har epilepsi, kramper, er gravid, i l\u00f8pet av de siste 3 m\u00e5nedene har gjennomg\u00e5tt en \u00e5pen s\u00e5roperasjon eller har f\u00f8dt barn. <br><br><strong>SYKDOM<\/strong><br>V\u00e6r oppmerksom p\u00e5 at hvis du har en infeksjon i kroppen p\u00e5 dagen for TRE\u00ae-behandlingen hos TRE\u00ae-leverand\u00f8ren, b\u00f8r du informere TRE\u00ae-leverand\u00f8ren s\u00e5 snart som mulig (helst dagen(e) f\u00f8r n\u00e5r det er gyldig), slik at du kan ombooke behandlingen til en annen dag. <\/p>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1990-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1990\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/nb\/wp-json\/wp\/v2\/pages\/1958#wpcf7-f1990-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/nb\/wp-json\/wp\/v2\/pages\/1958#wpcf7-f1990-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1990\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1990-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li class=\"active\">\n\t\t\t<p>Personlige opplysninger (1\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Flerdelte sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Medisinske tilstander\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Annet\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Signatur\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td width=\"50%\">\n\t\t\t<p><label>Fornavn <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"50%\" colspan=\"2\">\n\t\t\t<p><label>Etternavn <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"surname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"surname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td  width=\"50%\">\n\t\t\t<p><label>F\u00f8dselsdato <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date-of-birth\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"25%\">\n\t\t\t<p><label>Alder <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"age\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td  width=\"25%\">\n\t\t\t<p><label>Kj\u00f8nn <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"gender\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Male\">Mann<\/option><option value=\"Female\">Kvinne<\/option><option value=\"Other\">Annet<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Mobil <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cellphone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cellphone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Yrke <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>By <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Land <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"country\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>E-post <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>N\u00e6rmeste p\u00e5r\u00f8rende\/n\u00f8dkontakt - navn <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>N\u00e6rmeste p\u00e5r\u00f8rende \/ N\u00f8dkontakt - telefonnummer <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>N\u00e6rmeste p\u00e5r\u00f8rende \/ N\u00f8dkontakt <span class=\"disclosure-form-required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emergency_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"emergency_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n\n\n<!-- page 2 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Personlig informasjon\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Sp\u00f8rsm\u00e5l (2\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Flerdelte sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Medisinske tilstander\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Annet\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Signatur\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Har du gjort TRE\u00ae f\u00f8r? <span class=\"disclosure-form-required\">*<\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Hvis ja, beskriv din erfaring med TRE\u00ae - hvor lenge du har praktisert, hvor og n\u00e5r du l\u00e6rte det, hvor ofte du shaker og eventuelle viktige endringer som har skjedd. <\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"done-tre-before\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"done-tre-before\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Hva h\u00e5per du vil bli annerledes som f\u00f8lge av TRE\u00ae?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tre-expectations\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"tre-expectations\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Har du for tiden noen medisinske problemer? <span class=\"disclosure-form-required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medical-issues\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"medical-issues\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"medical-issues\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Nei<\/span><\/span><\/span><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Oppgi opplysninger om eventuelle hjertesykdommer, uregelmessig blodtrykk, epilepsi, diabetes eller p\u00e5g\u00e5ende kroniske smerter. <\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"medical-issues-comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"medical-issues-comment\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Har du noen form for sensorisk svekkelse (for eksempel syns- eller h\u00f8rselstap eller balanseproblemer)? <span class=\"disclosure-form-required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sensory-impariment\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"sensory-impariment\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"sensory-impariment\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Nei<\/span><\/span><\/span><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Hvis ja, vennligst forklar eventuelle sensoriske funksjonsnedsettelser:<\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sensory-impariment-comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"sensory-impariment-comment\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>F\u00e5r du for tiden (eller har du tidligere f\u00e5tt) psykiatrisk behandling, terapi eller r\u00e5dgivning for angst, depresjon eller andre psykiske helseutfordringer? <span class=\"disclosure-form-required\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"psychiatric-care\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"psychiatric-care\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"psychiatric-care\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">Nei<\/span><\/span><\/span><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Vennligst oppgi detaljer om all behandling du har mottatt i l\u00f8pet av de siste 12 m\u00e5nedene.<\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"psychiatric-care-comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"psychiatric-care-comment\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Hvilke medisiner (reseptbelagte eller reseptfrie), vitaminer, kosttilskudd eller naturmidler tar du regelmessig?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"vitamins-supplements-medications\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"vitamins-supplements-medications\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"4\">\n\t\t\t<p><label>Har du opplevd traumer i l\u00f8pet av de siste 24 m\u00e5nedene? <span class=\"disclosure-form-required\">*<\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Hvis ja, vennligst forklar (eller svar nei nedenfor):<\/small>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"trauma-last-24-months\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"trauma-last-24-months\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"25%\">\n\t\t\t<p><label>Er du gravid?<\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>(Kun for kvinner)<\/small>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"25%\">\n\t\t\t<p><label>Hvis ja, hvor mange uker?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant-weeks\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pregnant-weeks\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\" width=\"50%\">\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n\n<!-- page 3 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Personlig informasjon\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Flerdelte sp\u00f8rsm\u00e5l (3\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Medisinske tilstander\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Annet\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Signatur\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"table-4-choices\">\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>Nesten aldri\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>M\u00e5nedlig\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>Ukentlig\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\" valign=\"bottom\">\n\t\t\t<p>Daglig\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Hodepine eller migrene\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"headaches_migrations\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Smerter i rygg, nakke og skuldre\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"back_neck_shoulder_pain\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Smerter i bekkenet\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"pelvic_pain\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Smerter i kneet\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"knee_pain\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Fibromyalgi\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"fibromyalgia\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Allergier\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"allergies\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Ford\u00f8yelsesproblemer\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"digestive_issues\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Kvalme\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"nausea\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Bekymring\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"worry\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Sinne\/vrede\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anger_rage\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Tristhet\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"sadness\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Mangel p\u00e5 energi\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"lack_of_energy\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>S\u00f8vnl\u00f8shet\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"insomnia\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Irritabilitet\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"irritability\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Depresjon\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"depression\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Angst\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"anxiety\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td width=\"80%\">\n\t\t\t<p>Panikkanfall\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"hardly ever\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"monthly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"weekly\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td width=\"5%\" class=\"vertical\">\n\t\t\t<p><input type=\"radio\" name=\"panic_attacks\" value=\"daily\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table> \n\n <!-- page 4 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Personlig informasjon\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Flerdelte sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Medisinske tilstander (4\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Annet\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Signatur\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<p><strong>Hvis du har noen av f\u00f8lgende tilstander, vennligst velg ja eller nei. <\/strong>\n<\/p>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Uregelmessig blodtrykk (h\u00f8yt eller lavt) <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"irregular_blood_pressure\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"irregular_blood_pressure\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Hypo- eller hyperglykemisk (medisiner)<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"hypo_or_hyperglycaemic\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"hypo_or_hyperglycaemic\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Nylige operasjoner <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"recent_surgeries\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"recent_surgeries\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Uregelmessige hjertesykdommer (inkludert kirurgi, pacemakere og arytmi) <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"irregular_heart_conditions\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"irregular_heart_conditions\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Svimmelhet, s\u00e6rlig n\u00e5r du b\u00f8yer deg forover <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"vertigo_dizzyness\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"vertigo_dizzyness\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Psykologiske tilstander (som for eksempel PTSD) <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"psychological_conditions\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"psychological_conditions\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Kroniske smerter (fibromyalgi\/MS) <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"chronic_pain\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"chronic_pain\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Kronisk utmattelse (ME)<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"chronic_fatigue\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"chronic_fatigue\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>ADHD ADD <\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ADHA\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ADHA\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Autisme<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Autism\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Autism\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Avhengighet<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Addiction\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Addiction\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Andre og\/eller ytterligere detaljer fra informasjonen ovenfor (vennligst beskriv nedenfor)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_condition\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_condition\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><strong>VIKTIG: Hvis du har noen av f\u00f8lgende tilstander, anbefaler vi at du kun arbeider med sertifiserte TRE\u00ae-behandlere som har erfaring med behandling av disse tilstandene. (Hvis du har en terapeut eller venn, kan du ta med deg vedkommende for \u00e5 l\u00e6re TRE\u00ae eller st\u00f8tte deg med TRE\u00ae i en-til-en-timen). Og ikke ta de f\u00f8rste TRE\u00ae-\u00f8ktene i en gruppe.<\/strong>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Manisk\/depressiv<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"manic_depressive\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"manic_depressive\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Bipolare tilstander<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"bipolar_conditions\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"bipolar_conditions\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Schizofreni<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"schizophrenia\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"schizophrenia\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Alvorlig depresjon<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"severe_depression\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"severe_depression\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Psykose<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"psychosis\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"psychosis\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Borderline personality disorder<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Borderline_personality_disorder\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Borderline_personality_disorder\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"No\">Nei<\/option><option value=\"Yes\">Ja<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<tr>\n\t<td colspan=\"2\">\n\t\t<p><label>Detaljert beskrivelse fra informasjonen ovenfor (vennligst beskriv nedenfor)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_condition\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_condition\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/td>\n<\/tr>\n\n<!-- page 5 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Personlig informasjon\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Flerdelte sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Medisinske tilstander\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Annet (5\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Signatur\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>P\u00e5 en skala fra \u00e9n til ti, der ti er det mest intensive, hvordan vil du vurdere f\u00f8lgende p\u00e5 en gjennomsnittsdag?<\/label>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Fysiske smerteniv\u00e5er?<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"physical_pain_levels\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"physical_pain_levels\"><option value=\"\"><\/option><option value=\"0\">0<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Emosjonelle smerteniv\u00e5er?<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"emotional_pain_levels\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"emotional_pain_levels\"><option value=\"\"><\/option><option value=\"0\">0<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>N\u00e5v\u00e6rende stressniv\u00e5?<\/label><span class=\"disclosure-form-required\">*<\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"current_stress_levels\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"current_stress_levels\"><option value=\"\"><\/option><option value=\"0\">0<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label>Har du noen andre bekymringer du \u00f8nsker \u00e5 dele f\u00f8r du deltar p\u00e5 en TRE\u00ae-\u00f8kt?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_concers\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_concers\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"2\">\n\t\t\t<p><label> Har du noen sp\u00f8rsm\u00e5l om TRE? \u00ae f\u00f8r v\u00e5rt planlagte m\u00f8te?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other_questions\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_questions\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n\n\n<!-- page 6 -->\n<div class=\"disclosure-form-steps\">\n\t<div class=\"bg\">\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>Personlig informasjon\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Flerdelte sp\u00f8rsm\u00e5l\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Medisinske tilstander\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Annet\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li class=\"active\">\n\t\t\t<p>Underskrift (6\/6)\n\t\t\t<\/p>\n\t\t<\/li>\n\t<\/ul>\n<\/div>\n\n<!-- signature -->\n<table class=\"disclosure-form-table\" width=\"100%\">\n\t<tr>\n\t\t<td>\n\t\t\t<p><label>Skriv underskriften din <span class=\"disclosure-form-required\">*<\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p><small>Tips: Bruk musepekeren med venstre museknapp nede, og skriv 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TRE\u00ae is a safe and effective stress release technique for most people. The TRE\u00ae process should not be used as a substitute for trauma recovery procedures of a medical or psychiatric\/psychological nature. 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