top of page
Do any of the following apply to you?
Have you seen a Psychologist / Other Therapist in the past?
Do you take any prescription medications for mental health problems?
During the past week have you felt:
Are you quick to react with anger/frustration?
Are you an impulsive person? (e.g., drinking, eating, gambling, shopping)
Select any of the following that apply to you
Select any of the following that apply to you
How often do you have more than four alcoholic drinks in a day?
Have you every felt guilty about your drinking, or that you need to cut down?
Has anyone commented on your drinking, or suggested that you cut down?
How often do you use illegal drugs or prescription medication for non-medical reasons?
Have you every felt guilty about using illegal drugs or prescription medication?
In the past year, have you had an issue with gambling such as betting when you didn't have sufficient funds, or feeling guilty about betting?
Is there a current Apprehended Violence Order (AVO) in place that restricts any aspect of your behaviour?
Are you currently engaged in legal proceedings for any matter, including child custody or visitation issues?
bottom of page