My Journey Baseline | Epiphany360

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Forest Path

My Journey Baseline

PIN

Date

Approximately, how many weeks since your last visit?

Since your last visit are you generally better, worse or about the same? *

Better

Worse

About the same

Both better and worse

What is Better?

Worse?

Current Medications

If 0 is the worst and 10 is the best you can imagine, in the last week, how's your Mood?

Motivation?

Productivity?

Physical Energy?

Sleep?

Satisfaction with Life?

Social drive

Self-esteem?

Piece of Mind?

Feeling Accepted?

Feeling Open (the opposite of guarded)?

Overall function, this week

Copyright. No words or images from this website may be copied.This website is intended for general guidance only, not as a substitute for detailed research or the exercise of professional judgment. The information herein provided is on an “as is” basis and Obidou makes no representations or warranties, express or implied. This information is not meant to diagnose, treat or manage any mental health condition. If you are concerned about your mental health, please see your primary care provider or go to the nearest hospital emergency service.

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