1. What are your areas of most significant concern?

2. What are your most important challenges?

3. What are the essential features of your psychiatric or psychological history?

4. What psychiatric medications and psychotherapies have been utilized?

5. Is there any history of substance use or abuse or of compulsive behavioral patterns?

6. What are your patterns of eating, sleeping, and physical activity?

7. With what medical disorders or allergies do you suffer?

8. Who are your physicians or nurse practitioners? What are your medications or treatments?
 
9. Do you currently have a psychotherapist? If so, whom?
 
10. What is your family history of psychiatric disorders or addictions? If so, are you aware of successful treatments? 
 
11. What is your history of education, employment, marriage, and parenthood?
 
12. What are your personal strengths? What are your goals and aspirations?

Please email to:
atm@learningpsychiatrist.hush.com
Thank you.