Home
Blog
Relationships
Depression
Coaching
Divorce
Adolescents
About Dr. Goldstein
Article & Links
Search
Contact Me
Patient Preliminary Interview
Patient Preliminary Interview
If you are local to the Boca Raton FL area, and would like to have me perform a preliminary assessment please take a few moments to respond to all of the questions.
First Name
Last Name
Email
Phone Number
-
-
How decisive are you about making your mind up about things?
Very Indecisive
Somewhat Indecisive
Neither Decisive or Indecisive
Somewhat Decisive
Very Decisive
Have you lost pleasure or interest in things you used to enjoy?
Yes
No
Are you having trouble falling asleep or staying asleep?
Not Usually
Often
Sometimes
Most Nights
Are you more irritable lately, feeling resentful, and angry frequently?
Yes
No
Do you worry a lot?
Yes
No
Do you feel bad about yourself, your appearance, your accomplishments or your efforts?
Yes
No
Are you having trouble concentrating or focusing? Is it difficult to get things done?
Yes
No
