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Anxiety or Excessive Stress

Frequent Worry or Nervousness

Panic or Fear

Difficulty Focusing or Concentrating

Difficulty Starting or Completing Tasks

Difficulty Planning or Organizing Tasks & Projects

Forgetting or Losing Things

Autism

Relationship Problems

Social Isolation

Depression or Frequent Sadness

Tearfulness or Crying Spells

Grief or Loss

Mood Changes

Irritability

Anger or Difficulty Controlling Temper

Hopelessness

Self-Harming Behavior

(e.g., cutting)

Thoughts of Suicide

Thoughts of Hurting Others

Traumatic Event

Experienced Abuse or Domestic Violence

(e.g., physical, sexual, emotional)

Eating-Related Problems

(e.g., food restrictions, binging, purging)

Use of Drugs or Alcohol

Sexual Concerns

Financial Problems

Legal Problems

Divorce or Separation

Custody or Child Visitation Conflict

Other

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