Outpatient Assessment - Ages 11 to 17

Client Assessment Form

This Assessment form is to help our Clinicians better understand your situations . It is important to understand that this information is electronically delivered to a certified Clinician, and will not be shared with anyone without your prior consent. You will be contacted soon after completing this assessment to discuss Better Living Counseling Services outpatient therapy option.

Client Information
Client's contact phone number *
Client's contact phone number
Assessment
The questions below ask about things that might have bothered you. For each question, select the option that best describes how much (or how often) you have been bothered by each problem during the past TWO (2) WEEKS.
IN the past two weeks, have you...

Assessment derived from DSM-5 Cross-Cutting Symptoms Measure.  Copyright ©2013 American Psychiatric Association. Material reproduced with permission