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Application Wiedenhof
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Personal details
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Contact details
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E-mail address
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Addiction history
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Which drugs have you used?
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How long have you used these drugs?
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Have you already undergone therapy?
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Yes How many?
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6
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Where?
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State of health
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Do you have/have you had any physical illnesses?
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Which ones?
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Do you have / have you had any mental illnesses?
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Which ones?
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Faith
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Have you ever come into contact with the Christian faith?
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Through whom?
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Wiedenhof
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What are your wishes and goals for your time in our house?
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