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Initial Assessment for Individual Counseling

MENTAL HEALTH ASSESSMENT

"(Required)" indicates required fields

Thank you for taking a few minutes to answer these questions. Your responses and name will be kept strictly confidential and will not be shared outside of The Forge leadership. This will help provide important information on how we can best serve you in the counseling sessions.

RECENT SYMPTOMS

Please rate how much you have experienced each symptom over the past week (select the number).

a. Feeling sad, down or depressed(Required)
b. Avoiding certain people or places(Required)
c. Loss of interest in activities I normally enjoy(Required)
d. Low energy/feeling tired(Required)
e. Sleep problems (insomnia, not staying asleep, or early waking)(Required)
f. Eating too much or too little(Required)
g. Not able to think clearly(Required)
h. Feeling no pleasure or joy in life(Required)
i. Anxiety and worry(Required)
k. Angry outbursts(Required)
l. Low self-esteem or low self-confidence(Required)
m. Feeling guilty(Required)
n. Feeling stressed(Required)
o. Thoughts of suicide(Required)
p. Drinking or abusing drugs (including prescribed drugs)(Required)
q. Addictive behaviors (i.e. gambling, eating, porn, etc.)(Required)
r. Not getting my work done(Required)
s. Feeling unhappy with my workplace(Required)

The Forge offers biblical counseling to provide hope and help with the difficulties and temptations all men face. We are not a licensed counseling agency, but our biblical counselors have advanced degrees, certifications, and decades of experience in Christian counseling along with years of professional experience in churches and in the business world.

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The Forge Initiative Inc

Office Address:
6480 Sprint Pkwy, Suite I
Overland Park, KS 66211

Mailing address:
P.O. Box 11174
Overland Park, KS 66207

Phone: (913) 392-3147

Email: info@theforge.org

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A Christian 501 (c) (3) charitable organization serving men in the KC Metro area.
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