Angelika Vraka (MA)

AllAboutYouCounselling.com

Counselling & Psychotherapy  |  Face to Face & Online

Face To Face Client Questionnaire:
Your Name(*)
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Date of Birth(*)
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Gender(*)
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Email(*)
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Home number
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Mobile number
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Occupation
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What brings you to therapy
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Have you had any type of counselling before?
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Are you currently being treated by
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Are you currently taking any psychotropic medication (anti-depressants, anti-anxiety)? If so which?
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Please describe any negative feelings you might have?
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Have you ever felt suicidal or feel you might be now?
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Do you take any recreational drugs if so how often?
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Do you drink alcohol, if so how often?
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How would you like me to contact you?
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