Book A Consultation Home / Book A Consultation What brings you to treatment? Mental health history This will help your provider guide future conversations and care decisions. Have you received a psychiatric diagnosis? YesNo Have you seen a mental health professional in the past? YesNo Have you taken any psychiatric medications before? YesNo Have you ever stayed in a hospital or facility for mental health reasons? YesNo Medical history This will help your provider understand important details of medical history and recommend the best treatment for you. Do you have any allergies? YesNo Are you currently taking any medications? YesNo Do you have any medical conditions or chronic diseases? YesNo Sex assigned at birth FemaleMale Alcohol and substance use This will help your provider understand how alcohol or substance use might be impacting your wellbeing. Alcohol YesNo Tobacco/nicotine YesNo Cannabis (e.g. marijuana/pot/weed) YesNo Cocaine YesNo Hallucinogens (e.g. LSD/acid, psilocybin) YesNo Opioids (e.g. heroin, oxycodone, fentanyl) YesNo Methamphetamine YesNo Social context This will help your provider understand parts of your life and environment that affect your health and how they can support you. How would you describe your current relationships with the important people in your life (like friends, partners, or family)? Is there anything about your upbringing, childhood, or early life experiences you think your provider should know? Is there anything else you'd like your provider to know?