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Problem Severity Rating
Do you feel nervous or anxious?
Often
Half the time
Not often
Do you feel depressed?
Often
Half the time
Not often
Do you experience disconnection in your marriage?
Often
Half the time
Not often
Do your behaviors get you in trouble?
Often
Half the time
Not often
Are you experiencing family conflict?
Often
Half the time
Not Often
Have you experienced trauma?
Yes
I'm not sure
I don't think so
Do you want Blake to reach out to you?
Yes
No
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