Brief Follow-up Assessment


Please complete this form 1-2 days prior to the scheduled appointment. Your responses allow Dr. Borue to track treatment progress and focus the visit on the most pressing/relevant concerns instead of using up valuable time for routine screening questions. Your responses will viewed by Dr. Borue just prior to or during your scheduled appointment and entered as a part of the medical record. Forms must be submitted PRIOR TO the start of the appointment to be seen by Dr. Borue.

About your privacy:
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    Thoughts about suicide
    Desire to engage in self injurious behaviors
    Thoughts about killing another person
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