This questionnaire is designed to help Dr. Courtnee Pelton, Psy. D, understand
more about you. The primary purpose of asking these questions is to develop
a treatment plan that will best suit the reasons you are seeking assistance.
By completing these questions as completely and honestly as you can, Dr.
Pelton will be able to offer you treatment most in line with your reasons
for coming to this clinic.
Hint: Use the 'tab' key to switch between fields without using
For example, relationships with family and friends, or your desire to
Please rate how often the following has occurred over the past 2 weeks:
Please list 3 goals for treatment.