Describe Your Personality in Three Words.

Mental Health

Typical Mood:
________________________________________________________________________________________________________________________________________________

Describe Your Personality in Three Words:
________________________________________________________________________

If I were to ask someone who knew you pretty well, but was not a friend, to describe you; what would that person say?
________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you ever seen or heard things that were not really there? Yes or No?
If yes, describe the experience:
________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you have problems managing anger?
________________________________________________________________________________________________________________________________________________________________________________________________________________________

How do you deal with stress?
________________________________________________________________________________________________________________________________________________________________________________________________________________________

Mental Health History (Hospitalizations/Therapy? Who? What? When? Was it effective?)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________