The client assessment form should only be completed upon request. Next Select type of counselling Face to Face Online Face to Face and Online Back Next Are you currently taking medication? Select an option No Yes If applicable, list of medication Are you currently experiencing health issues? Select an option No Yes Are you currently experiencing sleep problems? Select an option No Yes Do you have any eating habit problems? Select an option No Eating Less Eating More Binging Restricting Do you drink alcohol? Select an option No Yes Do you use recreational drugs? Select an option No Yes Have you experienced any significant life stresses in the past year? Select an option No Yes Back Next Symptom Last 7 days In the past Not applicable Depressed mood Anxiety Panic attacks Mood swings Phobias Obsessive thoughts Repetitive behaviours Intrusive thoughts Flashback re trauma Eating disorder Body image problems Alcohol/substance abuse Relationship difficulties Learning disabilities Suicidal thoughts Suicide attempt Back Submit Form
