{"id":249,"date":"2025-09-10T03:51:46","date_gmt":"2025-09-10T03:51:46","guid":{"rendered":"https:\/\/www.socorrodiaz.com\/web\/?page_id=249"},"modified":"2025-09-16T19:12:21","modified_gmt":"2025-09-16T19:12:21","slug":"family-constellations-questionnaire","status":"publish","type":"page","link":"https:\/\/www.socorrodiaz.com\/web\/family-constellations-questionnaire\/","title":{"rendered":"Family Constellations Questionnaire"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#FCFAF3&#8243; custom_padding=&#8221;||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221; da_disable_devices=&#8221;off|off|off&#8221;][et_pb_row admin_label=&#8221;row&#8221; _builder_version=&#8221;4.27.4&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;_initial&#8221; text_font=&#8221;Poppins|300|||||||&#8221; header_2_font=&#8221;Roboto||||||||&#8221; header_2_text_color=&#8221;#263577&#8243; header_2_font_size=&#8221;46px&#8221; header_3_font=&#8221;Roboto||||||||&#8221; header_3_text_color=&#8221;#263577&#8243; header_3_font_size=&#8221;36px&#8221; header_3_line_height=&#8221;1.2em&#8221; header_6_font=&#8221;Roboto||||||||&#8221; text_orientation=&#8221;center&#8221; max_width_tablet=&#8221;100%&#8221; max_width_phone=&#8221;100%&#8221; max_width_last_edited=&#8221;off|desktop&#8221; custom_margin=&#8221;||10px||false|false&#8221; header_3_font_size_tablet=&#8221;20px&#8221; header_3_font_size_phone=&#8221;16px&#8221; header_3_font_size_last_edited=&#8221;on|desktop&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Family Constellations<br \/>Intake Form<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Footer&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#FCFAF3&#8243; background_enable_image=&#8221;off&#8221; background_size=&#8221;custom&#8221; background_image_width=&#8221;30%&#8221; background_position=&#8221;bottom_right&#8221; animation_style=&#8221;fade&#8221; animation_delay=&#8221;200ms&#8221; animation_starting_opacity=&#8221;20%&#8221; saved_tabs=&#8221;all&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221; da_disable_devices=&#8221;off|off|off&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; max_width=&#8221;660px&#8221; animation_style=&#8221;fade&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;Poppins|300|||||||&#8221; header_3_font=&#8221;Poppins||||||||&#8221; header_3_text_align=&#8221;center&#8221; header_3_text_color=&#8221;#263577&#8243; header_3_font_size=&#8221;30px&#8221; header_3_line_height=&#8221;2em&#8221; text_orientation=&#8221;justified&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; text_text_color=&#8221;#040506&#8243; sticky_enabled=&#8221;0&#8243;]<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f247-o1\" lang=\"es-ES\" dir=\"ltr\" data-wpcf7-id=\"247\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/web\/wp-json\/wp\/v2\/pages\/249#wpcf7-f247-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulario de contacto\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"247\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_ES\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f247-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label>Full Name (First; Middle; Last): *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"full-name\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are you named after anyone and if yes, who? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"named-after\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"named-after\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Your Date of Birth: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"birth-date\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Where were you born? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"place-of-birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"place-of-birth\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>What is your heritage\/country of origin? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"heritage\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"heritage\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Where do you currently live? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"current-residence\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"current-residence\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>List the names and ages of your siblings in birth order, including yourself. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"siblings\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"siblings\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are you adopted, and if yes, do you know your birth parents? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adopted\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adopted\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are any of your siblings adopted? If yes, please name them. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adopted-siblings\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adopted-siblings\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are you married? Single? With a partner? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marital-status\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"marital-status\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Have you been married before or had other significant relationships? If so, please list the names of previous significant partners. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"past-partners\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"past-partners\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>If you have children, please list names and ages in birth order. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"children\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"children\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Have you experienced any miscarriages, abortions, stillbirths, or IVF? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"miscarriages\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"miscarriages\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Have you noticed any patterns in your family history? If yes, please explain. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"family-patterns\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"family-patterns\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Please check any of the following which apply to your family history: *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"family-history\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Early deaths\" \/><span class=\"wpcf7-list-item-label\">Early deaths<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Tragic events that seem to repeat themselves\" \/><span class=\"wpcf7-list-item-label\">Tragic events that seem to repeat themselves<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Repeated illnesses\" \/><span class=\"wpcf7-list-item-label\">Repeated illnesses<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Significant dates that events\/people share\" \/><span class=\"wpcf7-list-item-label\">Significant dates that events\/people share<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"War\" \/><span class=\"wpcf7-list-item-label\">War<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Immigration\" \/><span class=\"wpcf7-list-item-label\">Immigration<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Imprisonment\/locked away against their will\" \/><span class=\"wpcf7-list-item-label\">Imprisonment\/locked away against their will<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Adoption\" \/><span class=\"wpcf7-list-item-label\">Adoption<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Children given away\" \/><span class=\"wpcf7-list-item-label\">Children given away<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Secrets that no one in the family discusses\" \/><span class=\"wpcf7-list-item-label\">Secrets that no one in the family discusses<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Any betrayals or abandonment\" \/><span class=\"wpcf7-list-item-label\">Any betrayals or abandonment<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Sexual abuse\" \/><span class=\"wpcf7-list-item-label\">Sexual abuse<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Physical abuse\" \/><span class=\"wpcf7-list-item-label\">Physical abuse<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Addictions\/Alcoholism\" \/><span class=\"wpcf7-list-item-label\">Addictions\/Alcoholism<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h3>Your Session\n<\/h3>\n<p><label>What do you wish to explore in our session together? What issue(s) do you wish to look at? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"session-goals\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"session-goals\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Who do you call upon for comfort, support, and help? This may be a relative, friend, pet, partner, spiritual figure, or anyone you lean on: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"support-person\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"support-person\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cf7-btn-wrap\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enviar\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Family ConstellationsIntake Form\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f247-o2\" lang=\"es-ES\" dir=\"ltr\" data-wpcf7-id=\"247\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/web\/wp-json\/wp\/v2\/pages\/249#wpcf7-f247-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulario de contacto\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"247\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_ES\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f247-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label>Full Name (First; Middle; Last): *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"full-name\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are you named after anyone and if yes, who? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"named-after\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"named-after\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Your Date of Birth: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"birth-date\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Where were you born? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"place-of-birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"place-of-birth\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>What is your heritage\/country of origin? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"heritage\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"heritage\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Where do you currently live? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"current-residence\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"current-residence\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>List the names and ages of your siblings in birth order, including yourself. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"siblings\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"siblings\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are you adopted, and if yes, do you know your birth parents? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adopted\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adopted\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are any of your siblings adopted? If yes, please name them. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adopted-siblings\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adopted-siblings\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Are you married? Single? With a partner? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marital-status\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"marital-status\" \/><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Have you been married before or had other significant relationships? If so, please list the names of previous significant partners. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"past-partners\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"past-partners\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>If you have children, please list names and ages in birth order. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"children\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"children\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Have you experienced any miscarriages, abortions, stillbirths, or IVF? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"miscarriages\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"miscarriages\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Have you noticed any patterns in your family history? If yes, please explain. *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"family-patterns\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"family-patterns\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Please check any of the following which apply to your family history: *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"family-history\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Early deaths\" \/><span class=\"wpcf7-list-item-label\">Early deaths<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Tragic events that seem to repeat themselves\" \/><span class=\"wpcf7-list-item-label\">Tragic events that seem to repeat themselves<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Repeated illnesses\" \/><span class=\"wpcf7-list-item-label\">Repeated illnesses<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Significant dates that events\/people share\" \/><span class=\"wpcf7-list-item-label\">Significant dates that events\/people share<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"War\" \/><span class=\"wpcf7-list-item-label\">War<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Immigration\" \/><span class=\"wpcf7-list-item-label\">Immigration<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Imprisonment\/locked away against their will\" \/><span class=\"wpcf7-list-item-label\">Imprisonment\/locked away against their will<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Adoption\" \/><span class=\"wpcf7-list-item-label\">Adoption<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Children given away\" \/><span class=\"wpcf7-list-item-label\">Children given away<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Secrets that no one in the family discusses\" \/><span class=\"wpcf7-list-item-label\">Secrets that no one in the family discusses<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Any betrayals or abandonment\" \/><span class=\"wpcf7-list-item-label\">Any betrayals or abandonment<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Sexual abuse\" \/><span class=\"wpcf7-list-item-label\">Sexual abuse<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Physical abuse\" \/><span class=\"wpcf7-list-item-label\">Physical abuse<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Addictions\/Alcoholism\" \/><span class=\"wpcf7-list-item-label\">Addictions\/Alcoholism<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h3>Your Session\n<\/h3>\n<p><label>What do you wish to explore in our session together? What issue(s) do you wish to look at? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"session-goals\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"session-goals\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<p><label>Who do you call upon for comfort, support, and help? This may be a relative, friend, pet, partner, spiritual figure, or anyone you lean on: *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"support-person\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required cf7-input\" aria-required=\"true\" aria-invalid=\"false\" name=\"support-person\"><\/textarea><\/span><br \/>\n<\/label>\n<\/p>\n<div class=\"cf7-btn-wrap\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enviar\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","om_disable_all_campaigns":false,"_joinchat":[],"footnotes":""},"class_list":["post-249","page","type-page","status-publish","hentry"],"acf":[],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/pages\/249","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/comments?post=249"}],"version-history":[{"count":5,"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/pages\/249\/revisions"}],"predecessor-version":[{"id":436,"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/pages\/249\/revisions\/436"}],"wp:attachment":[{"href":"https:\/\/www.socorrodiaz.com\/web\/wp-json\/wp\/v2\/media?parent=249"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}