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Emotional Wellness Session
Questionnaire
First name
Last name
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Age
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Cultural Background
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Have you previously sought any mental health services, such as therapy or counseling? If so, please share your experiences.
Are you currently using any medications or therapies for emotional or mental health?
Can you identify specific emotional triggers or reactions you want to address?
How do you usually cope with emotional distress or triggers?
Are there any significant past experiences or traumas that you feel have impacted your emotional responses?
Describe your typical day, including any routines that are important to you.
What activities or hobbies bring you joy or relaxation?
Describe the support network you have, including friends, family, or community groups.
What do you hope to achieve through our sessions?
Is there anything specific you want to ensure we cover or focus on in our sessions?
Is there any other information you think is important for me to know to better understand and assist you?
I confirm that the information provided above is accurate and consent to share this information for the purpose of our sessions.
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