Make Stress A Thing Of The Past

(516) 428-2841

Trauma History

    Stress Solutions of New York/Apex Counseling

    Trauma History Form

    Have you experienced any of the following?


    VerbalPhysicalNot applicable

    VerbalPhysicalNot applicable

    VerbalPhysicalNot applicable

    Mother & FatherSelf

    Death of loved ones:

    Victim of bullyingBerated by teachers

    Intrusive memoriesFlashbacksAvoidance Behaviors

    Falling asleepShortened sleepInterrupted sleepExcessive sleep