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Client History Form - Part 2

This is the continuation of Form Part 1. 

Please note that this information is confidential.

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MENTAL HEALTH AND SOCIAL HISTORY

Have you or anyone in the family attended therapy in the past or is currenty recieving treatment

If yes, please indicate the following:

Have you or anyone in the family have suicidal thoughts / attempts / self-harm (cutting, etc...) recently or in the past?

If yes, please indicate the following:

Have you or anyone in the family been a victim of, or perpetrator of, child abuse (physical, sexual,emotinal,neglect...), domestic violence, rape, or other violent acts?

If yes, please indicate the following:

Have you or anyone in the family have trouble with alocohol or other substances now or in the past?

If yes, please indicate the following:

Have you or anyone in the family been involved with the legal system (probation,parole,jail,prison,DUI)? Any current or pending civil lawsuits?
Were you adopted? If yes, do you have a relatonship with your biological parents?
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