What led to your decision to search the internet for help? Tell me what's going on in as much detail as necessary.
Tell me about any medical problems you have or have had - chronic illnesses, traumatic injuries, head injuries, major surgeries, chronic pain. If none, write "none."
Tell me about any previous psychiatric hospitalizations (when, where, why), any previous or current mental health counseling, any previous or current psychiatric medications you have taken (when, what, and any benefits or side effects), and any previous or current diagnoses you been given. If none, write "none."
If you are experiencing "suicidal thoughts," "homicidal thoughts," "self-cutting/self-harming behaviors," or "bizarre or unusual behaviors," please explain in more detail. Tell me about your history of using alcohol and drugs, including cigarettes and any abuse of medications. For example, tell me when you started using alcohol, when it became a problem (if it did), and your current use in the past year and past week. The same for any other drugs - marijuana, cocaine, crack, heroin, etc.. If you have no history, then write "none."