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1. Have you followed through with your discharge plan given to you upon discharge?

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2. Are you continuing to see a therapist?

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3. Are you continuing to see a Psychiatrist?

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4. Are you staying medication compliant?

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5. Have you attended any mental health/recovery meetings?

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6. If so, how many per week?

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7. Your level of anxiety and/or depression prior to coming to Montare?

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i We adjusted the number you entered based on the slider’s scale.

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8. Your level of anxiety and/or depression today?

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i We adjusted the number you entered based on the slider’s scale.

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9. Your sense of hope (purpose) before coming to Montare?

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i We adjusted the number you entered based on the slider’s scale.

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10. Your sense of hope (purpose) after coming to Montare?

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i We adjusted the number you entered based on the slider’s scale.

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11. How would you rate your overall well-being today?

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i We adjusted the number you entered based on the slider’s scale.

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12. Any additional comments or suggestions?

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