Online Mental Disorders Questionnaire

Online Mental Disorders Questionnaire — the quickest way to learn about treatment options and understand your symptoms at our clinic. Start here to gain clarity and take the first step toward mental wellness.

Mental Disorders Questionnaire

First Name

Country

Date of Birth

Phone Number

When did the problem begin, and what symptoms do you experience?

What mental and physical issues are you dealing with now?

What symptoms appeared during severe episodes?

Do you have any health conditions (allergies, seizures, fainting, hallucinations, depression)?

Have you taken any prescribed medication?

Have you received treatment before? If so, where, how, and what were the results?

Note: