Online Assessment

Welcome! The following questions will give me a rough idea of where you are, which is the only place we can start. Both members of a couple need to fill out this form. See the separate form for addictions and relapse.

Name
Email
Phone
Did some specific event lead you to seek help at this time? Please describe what happened - the who, what, where, and when.
What was the most frustrating thing for you about this event?
What did the event tell you, about yourself, about reality, and about the need for some sort of help?
Has this sort of thing happened before? If so, what do you make of that?
What do you think you may need to change?
What do you think you may need to accept?
Does someone else think you need to change? Who?
If so, what is there frustration with you?
Do you agree with them?
What is your frustration with them, if any? What would you like them to change?
Rate your willingness to do something different to solve the problem from “1” (thinking about it) to “10” (go to any length).