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Screening Quiz

1. Are you “actively” suicidal, meaning that you would like to end your life? (Note that we’re not talking about just having “thoughts” about ending your life; this means you really would like to end your life and are actively considering doing so.)
2. In the past five years, have you attempted to end your life?
3. Have you or your partner been involved in an affair that is bothering you a lot (or, if you are seeking marriage/relationship services, is bothering your partner a lot)?
4. Personality disorder – have you (or your partner, if seeking marriage/relationship services) been diagnosed with a personality disorder (borderline personality disorder, narcissistic personality disorder, etc) or believe you (or your partner) may have a personality disorder?
5. How would you rate your MOOD for the past few weeks?
6. In, general, how well are you functioning in life?

Thank you for submitting

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