::: The First Step :::::::::::::::::::::::::::::::::::::::::::::::::::::

The most important aspect of starting on the road to happiness is taking the first step... Determining if you need help. Many individuals living with psychological disorders believe that their state of mind is normal, and that they are doomed to a life of pain and anguish. Others believe that no one will understand what they are going through, or that they will be ridiculed or viewed as "weak" if they seek therapeutic assistance. These perceptions, themselves, can be caused by the very disorders for which therapy is required.

For this reason, we have provided the following questionnaire to help you identify possible psychological disorders you may have, and to provide a helping hand in taking your first step toward happiness.

No personal information is collected in the submittal of this questionnaire. The results are viewable only by you.

YES NO
Do you feel "Down" or "Blue?"

YES NO
Do you worry a lot?

YES NO
Are you stuck in your primary relationship?

YES NO
Are you feeling shy, insecure or lonely?

YES NO
Do you have any addictions?

YES NO
Are you trapped in a dead-end job or career?

YES NO
Do you suffer from low self esteem?

YES NO
Are you stressed-out?

YES NO
Are your interpersonal relationships unsatisfying?

YES NO
Is your partner abusing you?

YES NO
Are you an adult survivor of childhood abuse?

Conditions
I understand that this questionnaire is intended as a general guide and is NOT, under any circumstances, to be considered a valid diagnosis. I hereby dismiss any liability of Laura Essen, M.S.W.; L.C.S.W. , in regards to the use of this questionnaire. By submitting this form, I confirm that I have read and understand these conditions.

YES NO
Do you agree to the above conditions?


 
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