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