• Adult Biopsychosocial History

    Lisa Inoue LMSW PLLC
  • In preparation for our first appointment, please complete the following questions to the best of your ability. The information will help me to better understand your current life circumstances, your concerns, your strengths, and your goals for seeking psychotherapy. Feel free to leave blank any questions that are not relevant to you or that you would prefer not to answer with the exception of the questions related to past experiences with harm to self or others.

  • Identifying Information

  • Psychotherapy Goals

  • Health and Wellness

  • Please indicate the amount and frequency of use of the following.

  • Mental Health

  • Relationships and Current Family

    If applicable, please give the approximate date your present partner relationship began. If applicable, please provide information about your partner and/or children.
  • * E = Excellent, G = Good, F = Fair, P = Poor

  • Relationship with Self and Others (Besides Partner)

  • Education

  • Work

  • Spirituality/Religion

  • Legal

  • Other

  • Clear
  •  -  -
    Pick a Date
  • Should be Empty:
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