Client Checklist & Concerns

Please check any and all of the following that apply to you.

Academic Concerns

Abuse of Others

Abuse by Others

Irritability

Phobias

Panic Attacks

Impulsivity

Heart Palpitations

Dizziness

Chronic/Frequent Illnesses

Eating Disorder

Ideas about Harming Self

Ideas about Harming Others

Mood Swings

Poor Self-Concept

Isolation

Concerns about Family

Sexual Concerns

Alchohol/Drug Use

Others' Alcohol/Drug Use

Memory Impairment

Aggression

Anxiety

Fears

ADD/ADHD

Physical Concerns/Challenges

Chronic Pain

IBS

Eating Issues/Concerns

Hopelessness

Shyness

Low Self Esteem

Concerns about Children/Parenting

Financial Concerns

Anger

Stress

Distractibility

Fatigue

Sleep Problems

Depression

Suicidal Thoughts

Loneliness

Negative Self Talk

Recent Loss

Relationship Concerns

Disorganization

Career Concerns

Other