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Client Self-Assessment Questionnaire:
Do You Need Therapy?

Thank you for considering therapy as a potential resource for your well-being. Please take a moment to reflect on the following questions. Your responses are confidential and will help you gauge whether therapy might be beneficial for you.

Emotional Well-being:

Relationships:

Are you experiencing difficulties in your relationships (family, friends, romantic)? Required
Do you find it challenging to communicate effectively with others? Required

Coping Strategies:

Life Changes:

Have you recently experienced significant life changes (e.g., loss, job change, relocation)? Required
How have these changes affected your daily life and overall well-being? Required

Self-Esteem and Confidence:

How would you rate your self-esteem and confidence levels? Required
Do you struggle with self-doubt or negative self-talk? Required

Sleep and Energy:

How is your sleep quality and duration? Required
Do you often feel fatigued or lack energy during the day? Required

Physical Health:

Have you noticed any physical symptoms (e.g., headaches, digestive issues) related to stress or emotional challenges? Required
Do you have any chronic health conditions that impact your daily life? Required

Goal Setting:

Are you having difficulty setting and achieving personal or professional goals? Required
Do you feel a sense of direction and purpose in your life? Required

Decision-Making:

Do you find it challenging to make decisions, big or small? Required
Have you noticed a pattern of indecision or second-guessing? Required

Personal Insight:

Are you open to self-reflection and personal growth? Required
Do you feel there are aspects of your life that you would like to explore further with a professional? Required

Thank you for your submission. Someone from out staff will be in touch.!

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