Please complete this form to the best of your ability.

This section helps to give the therapist who will be analyzing your responses essential background information to help make your plan ass effective as possible

Section A

Section B

This section helps the therapist pinpoint the emotion/s that will most likely stop you from ever learning to cope better so you know what emotions to focus on to get the best outcomes.

Low mood (Scores)

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Anxiety levels (Scores)

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Section C

This section helps the therapist pinpoint the strengths that sabotage you. This are the unexpected good things which work against you, and stop you from remaining emotionally resilient

How I describe myself

Tick phrases that feel like how you might describe yourself. And for each one you tick, please give a detailed answer to the related question.

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