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About Us
Important Things To Know
Our Clinical Team
Our Support Team
Mission Vision Values
Our Environment
Careers
Assessments
Adults
Children
Teens
Psychotherapy
Adults
Teens
Children
Workshops
New Clients
Our Promise to You
Quick 1st Appointment
Our Clinical Approach
What to Expect
Virtual Services
Fees + Coverage
FAQs
Resources
Videos
Articles
Infographics
Questionnaire
Contact
Mental Health Questionnaire
Answer each question, then click ‘next’ to continue.
Mental Health Screening Questionnaire - Adults
0% Complete
1 of 12
Outcome
3-23 -
Worried that something bad will happen to those you love
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
8-19 -
Low self-worth
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-10 -
Lack of attention to detail
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-16 -
Unable to multi-task
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-17 -
Keeping yourself constantly distracted in order to prevent thinking about a traumatic/stressful event
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-2 -
Difficulties with procrastination
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-2 -
Feeling as if you are on alert
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
1-1 -
Unable to concentrate (e.g., at work, reading, watching television)
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
7-7 -
Hid use of alcohol and/or substances
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-19 -
Having difficulties problem solving, concentrating, remembering important items, and/or paying attention, since experiencing a traumatic/stressful event
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
2-8 -
Difficulty controlling your emotions
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
7-3 -
Have consistently consumed more than 5 drinks for males (or 4 for females) in one sitting
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
3-9 -
Feeling shaky, dizzy, or unsteady
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
6-12 -
Believing that god or a celebrity is in contact with you
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-7 -
Hyperfocusing (e.g., sustained, intense concentration on a single interest or project for an extended period of time)
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
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