This questionnaire is an important part of providing you with the best health care possible. It is a snapshot of your internal world to date. Your answers will help in understanding any of the problems that you may have and will form the basis of a treatment plan.
Please answer every question to the best of your ability unless you are requested to skip over a question.
You can use the Tab key to choose questions and the Arrow keys to choose a response to each question.
Please use the Submit button to send this form back to me. We will explore th results at our next meeting