PART 1: BACKGROUND AND CURRENT CONCERNS
Emergency Contact Details
This form is intended to help me understand you, your present concerns, and your needs in our work together. If you have any questions or if you are not clear about any of these items, please put a question mark (?) and we can talk about it together in our next session.
What are your sources of strength?
For example when someone is feeling depressed it can become difficult for them to be kind to themselves or others.
Please read each statement and select a number 0, 1, 2, or 3 which indicates how much the statement applied to you OVER THE PAST WEEK. There are no right or wrong answers. Do not spend too much time on any one statement.