LIFE HISTORY QUESTIONNAIRE
The purpose of this questionnaire is to obtain a comprehensive picture of your background. By completing these questions as fully and as accurately as you can, you will facilitate your therapeutic program. You are requested to answer these questions in your own time instead of using up time during your session.
It is understandable that you might be concerned about what happens to the information about you because much or all of this information is highly
personal. Case records are strictly confidential. NO OUTSIDER IS PERMITTED TO SEE YOUR CASE RECORD WITHOUT YOUR PERMISSION.