User Details

ID : 14503 Assigned Doctor : kandi Morris

Date of Application : 2022-10-02 09:27:01 Name : Daphne Reynolds
Email : siwas@mailinator.com Phone : +1 (688) 104-9451
Gender : Female D.O.B : 03/03/2022
Address : Molestiae exercitati City : Tempore ea dolor au
State : Missouri Zip Code : 78944
Pets Name : Chuki, Test2, Tet4 Pets Age : 3, 3, 2
Pets Breed : Deshi, Deshi, Wz Pets Weight : 6, 7, 5
Pets Gender : Male, Male, Male DSM Type : Anxiety

Q: During the past six months have you been frequently worried about big or small events in your life?
A: True

Q: If you answered YES to Question #1, how frequently has your worrying caused anxiety or stress in the
last six months?
A: Never

Q: If you answered YES to Question #1 above describe what kind of events you worry about, and what
happens to you when you worry.
A: Eaque sint ipsam opt

Q: Do people ever say you worry about things too much?

A: True

Q: Do you think you worry about things too much?

A: False

Q: Do you have difficulty controlling your worries or anxiety?

A: False

Q: How long have you had difficulty controlling your worries in the past 12 months?
A: Rarely

Q: When worried do you frequently feel irritable or on edge for no apparent reason?
A: True

Q: Do you often worry something bad is going to happen to you or someone close to you?
A: False

Q: Do you have difficulty sleeping due to your anxiety and worrying?

A: True
Q: Do you suffer from muscle tension and aches due to anxiety and worry?
A: False

Q: Do you often become tired easily or experience a sudden unexplained loss of energy?
A: False

Q: Does your worrying interfere with any major life activity? (Major Life Activities include, but are not
limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking,
standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating,
and working.)
A: True

Q: If you answered YES to Question #13, please explain how your worrying interferes with your daily life
activities. Please provide as much information as possible.
A: Ratione velit possim

Q: What symptoms effect your day to day functioning?

A: Error non tenetur ea

Q: How is your functioning effected? Consider different life areas such as school, work, social, family and
self-care.
A: Itaque quas cumque t

Q: Does your animal assist you in coping with your emotional or mental health symptoms?
A: False

Q: If you answered YES to Question #17, please explain how your animal provides you with emotional
and/or mental support.
A: Ducimus molestiae d

Q: What does your animal do to help reduce symptoms and improve your day to day functioning? Think
about behavioral things that are changed as a result of your animal being a part of your life.
A: In et nostrum minima

Q: Do you have any additional information you would like to add for the therapist to know about?
A: Atque ullamco velit