• Your Mental Health

    This series of short forms will help your therapist understand more about you and your unique mental health profile. From this, she can get started on designing an individualized approach to most effectively meet your needs.
  • If you get started and find that you need to complete the form later, click "save" at the bottom, and you will be asked to enter your email. You'll be sent a link to complete it later if you want to do so on another device or browser.

  • Your Mental Health History

  • What medications are you taking?

  • Overall Life Satisfaction

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  • Family Mental Health History

    Does your family have a history of any of the below?
  • Have you ever been professionally diagnosed with a mental health disorder (e.g. anxiety or depression)?

    (Please note a google self-diagnosis doesn't count ;)
    • I think I might have symptoms of: 
    • Do you suspect you may have symptoms of a disorder?  If so, please list below, and the therapist will evaluate you for any of these.

  • Common Situations That May Adversely Affect Your Mental Health

    • Recent Stressful Events  
  • Anxiety and Depression

  • Over the last 2 weeks, how often have you been bothered by the following symptoms:

     

    0 = Not at all

    1 = Several Days

    2 = More than Half the Days

    3 = Nearly Every Day

     

  • PTSD

  • Sometimes, things happen to people that are unusually frightening, horrible, or traumatic.

    For example:

    • a serious accident or fire
    • a physical or sexual assault or abuse
    • an earthquake or flood
    • a war
    • seeing someone be killed or seriously injured
    • having a loved one die through homicide or suicide

    In the past month, have you:

  • Risk of Self Harm

  • NATIONAL SUICIDE PREVENTION HELPLINE:  1-800-273-8255

  • Clear
  • Phew!

    With all that info, your therapist will be able to start working to develop your personalized treatment approach.
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