Admissions Psychological History Have you ever been a patient or an outpatient at a mental hospital or under psychiatric care? Please list hospital and dates. Have you ever been institutionalized for a mental disorder for a prolonged period of time. Please explain and give detailed dates. * Please check Yes or No if you suffer from the following emotional problems. * Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 12345678910111213141516171819202122232425262728293031 Depression * Yes No Mood Swings * Yes No Anxiety * Yes No Agressiveness * Yes No Hear Voices * Yes No Multiple Personality Disorder * Yes No Paranoia/Schizophrenia * Yes No Bipoloar Disorder * Yes No Suicidal Thoughts * Yes No Suicide Attempts * Yes No Can you agree not to attempt while in treatment? * Yes No Homicide Attempts * Yes No Homicidal Thoughts * Yes No |Welcome| |Our Mission| |Our Services| |The TC| |For Women| |Children Services| |Exec. Director| |Health Center| |Job Training| |Outpatients| |FAQ| |Admissions| |Adm. Personal History| |Adm/Med/history| |Adm./Psycho/History| |Directions| |Odyssey Links| |Contact Us| |About| Hosted by AbleTeam.com