Pre-Screening Survey | Cedar Tree Counseling of Oklahoma

Pre-Screening Survey

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Patient Pre-Screening

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At Cedar Tree Counseling, we are committed to your well-being and personal growth. Our therapists are dedicated to staying abreast of the latest research and therapeutic approaches to ensure the highest quality care. We strive to create a therapeutic experience that empowers you to overcome obstacles, develop effective coping strategies, and cultivate resilience.

 

Patient Pre-Screening Survey

Personal Information

Contact Information

Mailing Address

Medical Questionnaire

Addiction Alcohol use Anxiety Attention issues Avoidance Bullying Body image issues Chronic pain/illness Depression Disordered eating Dissociation Feeling worthless Grief/loss Guilt Hallucinations Hopelessness Hyperactivity Issues Impulsive Irritable/ Angry Life transitions Low self-esteem/self-worth Nightmares No Motivation Obsessive-thoughts Panic attacks Parent/child estrangement Phobias/fears Posttraumatic stress disorder Relationship Issues Sadness Shame Self-harming behaviors Sexual identity/expression Sleep difficulties Social anxiety Stress Suicidal thoughts Trauma Trust Issues