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No other information will be disclosed. Signature Why are you seeking therapy at this time Check any symptoms you have exhibited in the past six months Sadness/Crying Spells Nervousness Socially Isolated Irritable/Temper Outbursts Weight Loss or Gain Persistent Thoughts Insomnia Hallucinations Excessive Sleep Delusions Feelings of guilt Excessive Worrying Difficulty Having Fun Nightmares Excessive Anger/Hostility Fidgety Suicidal Thoughts/Statements Rapid mood change Easily Distracted...
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