Background Information – Kfar Saba 2019

This information will be seen only by the course instructors and, if appropriate, by our participant support person, who is a mental-health professional. We will treat it as completely confidential. Nonetheless, if you feel uncomfortable answering any of these questions, please feel free to leave them blank.

Name *
Name
Date of birth
Date of birth
Partnership status
Education
How would you describe your physical health?