What brings you to see us here at Reyes (Family) Therapy:
Have you (or the patient if not yourself) been expierencing any of the following:
Depression
Anxiety
Nervousness
Paranoia
Lack of sleep or sleeping too much
Poor appetite
Over eating
Nausea
Vomiting
Crying episodes
Irritable
Hearing or seeing things others dont seem to
Feeling hopeless
Feeling as if you let yourself or family down
Scared
Insecure
Low energy
Fidgety
Feeling distant or stand-offish
What Date & Time would be good for you:
Have you had thoughts about hurting yourself or others? If so have you planned how you will do so?
Yes, I plan to hurt myself.
Yes, I plan to hurt someone around me.
No, I dont wish to harm myself or those around me.
Yes, I plan to hurt myself and others.
Have you ever attempted suicide or homocide? If so how many times and why?
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