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Chiquita Turner, LCSW
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If you have any questions or would like to schedule an appointment, please don't hesitate to contact us. We are here to help.
First name
Last name
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What brings you to counseling at this time? Is there something specific, such as a particular event? Be as detailed as you can.
Specify all medications and supplements you are presently taking and for what reason.
Do you drink alcohol? Do you use recreational drugs?
Do you have suicidal thoughts? Have you ever attempted suicide? Do you have thoughts or urges to harm others?
Is there a history of mental illness in your family?
Is there anything else you would like for me to know at this time?
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