About
Locations
Miami
ADHD Treatment
Anxiety Treatment
Depression Treatment
Psychotherapy
Portland
ADHD Treatment
Anxiety Treatment
Depression Treatment
Psychotherapy
Seattle
Anxiety
ADHD & ADD
Mood
Pricing & Payment
Contact
×
Existing Patients
(206) 207-1382
About
Locations
Miami
ADHD Treatment
Anxiety Treatment
Depression Treatment
Psychotherapy
Portland
ADHD Treatment
Anxiety Treatment
Depression Treatment
Psychotherapy
Seattle
Anxiety
ADHD & ADD
Mood
Pricing & Payment
Contact
Home
/
New clients
New clients
Do you currently have any heart conditions or taking any medication to treat high blood pressure?
Yes
No
Have you had bipolar, psychosis, schizophrenia, suicidal attempts, taken antipsychotics or any mental hospitalization history in the past?
Yes
No
Currently Suicidal thoughts /plan
Yes
No
Legal, disability, custody case pending -require determination
Yes
No
What are current symptoms concern?
ADHD
Anxiety
Depression
Self esteem
Unsure/not listed (write in)
