Private, Secure, Face to Face or Virtual Sessions.

fm=f ybANWWz

My Client Promise

I promise that I will be there for you, I will help you get to better know yourself, to learn to love and trust yourself, and with that, we will better be able to clarify whatever barriers stand in your way to a happier and more functional life, better mental health and begin to take steps to remove those barriers.

Our Treatment Focus

My focus in counseling is to help individuals heal, energize, and become aware of their inner strengths. I achieve this by providing a neutral safe space, listening to your concerns, and you and I will create your treatment plan, enabling us to maintain focus on your concerns and goals.

fm=f 5722
fm=f_V89OJxz

Informational

After you and I have discussed and agreed upon starting your exciting journey, please either:

  • Download and fill out the following forms, then email them to me directly. Or
  • Scroll down a bit further and you can fill them out right here and submit them.

If you feel uncomfortable filling out these forms, feel free to reach out to me directly.

fm=f_g0Y3roe

PATIENT HEALTH QUESTIONNAIRE (PHQ-9)

"*" indicates required fields

MM slash DD slash YYYY
Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “✔” to indicate your answer)
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usua
9. Thoughts that you would be better off dead or of hurting yourself in some way

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Total score - Depression severity
1-4 - Minimal
5-9 - Mild
10-14 - Moderate
15-19 - Moderately Severe
20-27 - Severe Depression
This field is for validation purposes and should be left unchanged.

GENERALIZED ANXIETY DISORDER (GAD-7)

"*" indicates required fields

MM slash DD slash YYYY
Over the last two weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid, as if something awful might happen

If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?

Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For research information, contact Dr. Spitzer at ris8@columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved. Reproduced with permission
Scoring GAD-7 Anxiety Severity
This is calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively, of “not at all,” “several days,” “more than half the days,” and “nearly every day.” GAD-7 total score for the seven items ranges from 0 to 21. 0–4: minimal anxiety 5–9: mild anxiety 10–14: moderate anxiety 15–21: severe anxiety
This field is for validation purposes and should be left unchanged.

Trauma PCL-5 WITH CRITERION A

"*" indicates required fields

MM slash DD slash YYYY
Instructions: This questionnaire asks about problems you may have had after a very stressful experience involving actual or threatened death, serious injury, or sexual violence. It could be something that happened to you directly, something you witnessed, or something you learned happened to a close family member or close friend. Some examples are a serious accident; fire; disaster such as a hurricane, tornado, or earthquake; physical or sexual attack or abuse; war; homicide; or suicide. First, please answer a few questions about your worst event, which for this questionnaire means the event that currently bothers you the most. This could be one of the examples above or some other very stressful experience. Also, it could be a single event (for example, a car crash) or multiple similar events (for example, multiple stressful events in a war-zone or repeated sexual abuse).
Did it involve actual or threatened death, serious injury, or sexual violence?
How did you experience it?
If the event involved the death of a close family member or close friend, was it due to some kind of accident or violence, or was it due to natural causes?
Second, below is a list of problems that people sometimes have in response to a very stressful experience. Keeping your worst event in mind, please read each problem carefully and then circle one of the numbers to the right to indicate how much you have been bothered by that problem in the past month.
In the past month, how much were you bothered by:
1. Repeated, disturbing, and unwanted memories of the stressful experience?
2. Repeated, disturbing dreams of the stressful experience?
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
4. Feeling very upset when something reminded you of the stressful experience?
5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
6. Avoiding memories, thoughts, or feelings related to the stressful experience?
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
8. Trouble remembering important parts of the stressful experience?
9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
10. Blaming yourself or someone else for the stressful experience or what happened after it?
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?
12. Loss of interest in activities that you used to enjoy?
13. Feeling distant or cut off from other people?
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
15. Irritable behavior, angry outbursts, or acting aggressively?
16. Taking too many risks or doing things that could cause you harm?
17. Being “superalert” or watchful or on guard?
18. Feeling jumpy or easily startled?
19. Having difficulty concentrating?
20. Trouble falling or staying asleep?
You and I will discuss your scores when we talk.
This field is for validation purposes and should be left unchanged.

Before we can start services, the below forms must be filled out and signed, and emailed to me at sheryl@falconcounseling.com.

CLIENT INFORMATION FORM
FALCON Counseling Office Policy and Client Agreement
FALCON Ack /receipt / notice of Privacy pract copy
FALCON Counseling HIPAA and Idaho Notice of Privacy Practices