1. Pre-Therapy Quesionnaire

Please read the instructions below before answering the questions.

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1. Your first name:

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2. Last 4 digits of your cell phone number:

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3. Your therapist's name:

INSTRUCTIONS: Please respond to every statement on the left side the screen by selecting one option on the right.
You can use the tab button to move from one drop-down list to the next. The further down each drop-down list, the more True you find the statement.
It's just a screening and we'll explain the purpose to you at your first appointment. Thank you!

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